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Full text of "Harvard medical alumni bulletin"

VINTER 2005 


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- ALUMNI BULLETIN 



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PRIDE AND 
PREJUDICE 

A historian uncovers the stories of 
the courageous young men — and 
one woman — who broke the race 
barrier at Harvard Medical SchooC 



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For more then 40 years Robert, 
Gross '31 transformed the practi< 
surgery, pediatrics, and cardiol< 
His innovations included the fir 
successful major surgery on the 
great vessels near the heart, with 
ligation of a patent ductus arteric 
in 1 938; the first corrective surge 
of coarctation of the aorta in 1 9i 
and one of the largest series in 
the world of successful open-he 
repairs of congenital anomalies t 
the heart in infants and children 



WINTER 2005 • VOLUME 7 S , NUMBER 3 



CONTENTS 



DEPARTMENTS 



Letters 3 

Pulse 5 

The debate on resident hours continues, 
and the Classroom of the Future debuts. 

President's Report 7 

by Joseph K.Hurd, jr. 

Bookmark 8 

A rc\ lew by Ehssa Ely of Escape Fire: 
Designs for the Future of Health Care 

Bookshelf 9 

Benchmarks 10 

Ad\ances in hearing research; suicide 
among female doctors; the self correct- 
< ing brain; Nurses" Health Study findings 

Class Notes 57 

Obituaries 61 

Endnotes 64 

A physician walks for a cure, 
bv Daniel j. Bresskr 



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Pride and Prejudice 14 

The first Harvard Medical School students of African descent 
predated the advent of affirmative action by more than a century. 
an interview wuh nora nercessian by eve higginbotham 

Taking a History 24 

Elaborate genealogical research helps one physician link himself to a 
long tradition of healers. bvMicHAEL lacombe 

Crossing the Meridian 32 

A pediatrician immerses himself in the study of acupuncture — and 
connects himself and some of his patients to an ancient legacy. 
bv earnest wu 

What Lies Beneath 38 

In working with refugees traumatized by mass violence, a medical 
student glimpses the power of the psyche to ra\'age the body. 

b V J A S O N H . W A S E Y 

Regarding Henry 44 

Dogged by ill fate, a failed musician turned Civil War hero becomes 
Harvard Medical School's generous, unlikely benefactor. 

bv JOSEPH B. MARTIN 

Practical Magic 50 

From remote mountain villages to refugee camps to inner-city 
neighborhoods, service learning students are stretching the bounds 
of an HMS education, bv b e v e r l y b a l l a r o 

Cover photograph: Laurel Keith '52 as a Tusheegee airman, courtesv of Stephen N. Keith 



I 



Harvarr] Medirnl 



ALUMNI 



U L L E T I N 




In This Issue 

N ONE OF THE CORRIDORS OF SYMPHONY HALL HANGS AN ENLARGED 

photograph of the Boston Symphony Orchestra with its greatest 
conductor. Serge Koussevitrky. In contrast to the orchestra's 
appearance today, two elements in this picture stand out; The seats are 
arranged differently. And they are all occupied by white men, save for a lone 
bassoonist. She was hired in 1945 and was the first woman other than a 
harpist to hold a chair in the orchestra. 

That same year the owners of the Boston Red Sox first invited African 
Americans to try out at Fenway Park. They passed over Jackie Robinson, 
and the team would not even halfheartedly integrate until 1959. 

By then Harvard Medical School was doing a slightly better job of foster- 
ing equal opportunity. For 80 years a trickle of determined, brave, and gifted 
African American men had trained at HMS, and in 1945 the School saw fit to 
admit its first women. 

Symphony Hall, Fenway Park, and Harvard Medical School all stand at the 
apices of a triangle in Boston's geography, and they have also become fixtures 
in the city's cultural, civic, and moral landscape. Under pressure, each has 
become visibly integrated, but the top leadership of each remains predomi- 
nantly (or exclusively) white and male — as is the case with comparable insti- 
tutions all over the country. Why is this? 

One can imagine an argument being made that the major symphony 
orchestras (for example) have white men as conductors at least in part 
because only white men have the genetic endowment to make great music. 
One can imagine it, but not with a straight face. Yet similar arguments about 
the temperament and genetic endowment of black people or women wanting 
to be physicians have been made within li\'ing memory. 

The historical fact is that cheesy theories about innate inclination and 
ability ha\'e long been the first refuge of those who would rationalize the 
lack of minorities in elite institutions. Step by step, experience has eroded 
these theories. The complexion of HMS has changed dramatically from 
\N'hat it was a generation or two ago, and so have assumptions about who 
can do what in medicine. This issue of the Bulletin joins the Alumni Associa- 
tion in celebrating 140 years of African American achievement, against great 
odds, at Harvard Medical School. 



EDITOR-IN-CHIEF 

William Ira Bennett '68 

EDITOR 

Paula Brewer Byron 

ASSOCIATE EDITOR 

Be\erly Ballaro, PhD 

ASSISTANT EDITOR 

Janice OLear)' 

BOOK REVIEW EDITOR 

Elissa Ely '88 



EDITORIAL BOARD 

Judy Ann Bigby '78 
Rafael Campo '92 

Elissa Ely '88 

Alice Elaherty '94 

Atul Gawande '94 

Robert M. Goldwyn '56 

Petri Klass '86 

\'ictoria McEvoy '73 

James J. O'Connell '82 

Nancy E. Oiiol '79 

Mitchell T. Rabkin '55 

Eleanor Shore '55 

DESIGN DIRECTOR 

Laura McFadden 



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ASSOCIATION OFFICERS 

Joseph K. Hurd, Jr. '64, president 

Steven A. Schroeder '64, president-elect 1 

A. W. Karchmer '64, president-elect 2 

Susan M. Okie '78, vice president 

PhyUis I. Gardner '76, secretary 
Kathleen E. Toomey '78, treasurer 

COUNCILLORS 

Nancy C. Andrews '87 
Wesley A. Curry '76 
Timothy G. Eerris '92 
Gerald S. Foster "51 
Donnella S. Green '99 
Linda S. Hotchkiss '78 

Lisa I. lezzoni '84 

Katherine A. Keeley '94 

Kenneth L Shine '61 

DIRECTOR OF ALUMNI RELATIONS 

Daniel D. Federman '53 

ASSISTANT DIRECTOR OF 
ALUMNI RELATIONS 

Patrick Rivera 

REPRESENTATIVE TO THE 
HARVARD ALUMNI ASSOCIATION 

Harold Bursztajn '76 
Joseph K. Hurd, Jr. '64 

The Harvard Medical Alumni Bulletin is 

published quarterly at 25 Shattuck Street, 

Boston, WA 02115 f by the Harvard 

Medical .Alumni .Association. 

Phone: (617) 384 8900 • Fax: (617) 384 8901 

Email: bulletin@hms.harvard.edu 

Third class postage paid at Boston. 

Massachusetts. Postmaster, send form 3579 

to 25 Shattuck Street, Boston, M.A 02115 

ISSN 0191 7757 • Printed in the U.S.A. 



HARVARD MEDICAL ALUMNI BULLETIN • WINTER 2005 



SECOND OPINIONS FROM OUR READERS | 



T.ETTEHS^ 



6 6 I am keenly aware of those situations in which 
tests are ordered, not so much to dehver good 
medical care, but rather to avoid being second- 
guessed at some hature date, perhaps by a jury" 



ft 



-LESTER KLEIN, MD 




Defensive Measures 

I enjoyed the essa)- Mitchell Rabkin '55 
wrote in the Summer 2004 edition of 
the Bulktin. "Can Humpty Dumpty Be 
Put Back Together?" As usual, Mitch is 
ahead of the curve in thinking about 
these issues. It occurs to me, though, 
that the costs associated with legal- 
defense practices should be addressed 
along with the other issues. 

As a urologist, I am keenly aware of 
those situations in which tests are 
ordered, not so much to deliver good 
medical care, but rather to avoid being 
second gues,sed at some future date, 
perhaps by a jury. We doctors are con- 
stantly aware of the potential legal ram- 
ifications of "acts of omission." I am sure 
there are estimates of the costs of defen 



si\'e medicine; they must be huge. .So how 
do we mitigate this situation? 

In answer to this, I ask you to consid- 
er my own practice. When I decide not 
to order a test or procedure that might 
be construed as "defen.sive" medicine, I 
document my thought process in the 
record. For example, if I decide not to 
order an intravenous pyelogram, or IVP, 
I will write a note stating: "In this situ- 
ation an IVP is not warranted." This 
note proves I contemplated the IVP but, 
based on my education, experience, and 
judgment, decided the test was not war- 
ranted. Now it may turn out that at 
some future date that patient may need 
an IVP, and that IVP may show a renal 
cancer. Would I be in trouble? I have 
reasoned that my decision not to order 
the test was soundly ba,sed (and docu 



mented) and equally or more valid than 
a decision to order the test. Assuming I 
was within the standard of care, is my 
position defensible in court? 

I would like to see an effort to create 
laws that support doctors who demon- 
strably consider options but do not 
necessarily act affirmatively, in place of 
what seems to be current law, which 
retroactively frames doctors for not 
doing a certain test or procedure. Per- 
haps this suggested doctrine is already 
law, in which case I would urge that it be 
widely promulgated among our peers. 

Good to see that Mitch Rabkin is still 
in the fray. 

LESTER KLEIN, MD 
BOCA RArON, FLORIDA 

Dejd Vu All Over Again 

I was frankly appalled at Mitchell 
Rabkin's article in the summer issue. I 
have been receiving the Bulletin for more 
than 30 years and ha\'e never felt com- 
pelled to write a letter to the editor — 
until now. 

Dr. Rabkin's ideas are not new. He 
essentially recommends capitation, which 
has been tried and failed. His proposal 
basically promotes not taking care of 
patients so as little as possible of the 
capitation is spent. He suggests that per- 
formance reviews and patient satisfaction 
surveys can temper this pitfall. The proh 
lem is that these arc difficult to do and are 
often biased. Dr. Rabkin also suggests 
a benefit from having the primary care 
physician fund referrals to specialists out 
of his capitation. This is a disincenti\'e to 
refer and can result in primary care physi- 
cians treating beyond their abilities. 

To borrow a simple analogy men- 
tioned to me years ago, I suggest that 
Dr. Rabkin capitate his auto mechanic. 
When Dr. Rabkin pulls up and tells the 
mechanic that he suspects his car's 
brakes aren't working well, and the 
mechanic says things seem fine, assessing 
the car from his desk 20 feet away, wiU 
Dr. Rabkin feel secure driving his car? 

As a practicing physician rather than 
an academic, and as a patient advocate. 



WINTER 2005 • HARVARD MEDICAL ALUMNI BULLETIN 



^ L E TXE R S 



I SECOND OPINIONS FROM OUR READERS 



1 view Dr. Rabkin's suggestions as 
unworkable. He is described as "a 
leader in medicine," which I am sure he 
is, but these ideas are neither new nor 
sound. I also feel they neither improve 
care nor benefit the patient. They may, 
in fact, work in the reverse. 

MICHAEL A. NIERENBERG '/I 
PALO ALTO, CALIFORNIA 

National Championship 

Thank you for correcting a significant 
omission. Se\eral times in the last few 
years both the Bi/!/cti)i and Harvard Maga- 
zine have made forays into covering 
the health care deh\-ery crisis. But even 
though some of the leading proponents of 
a comprehensive, government-sponsored 
solution are Har\'ard faculty mem- 
bers, that argument has been largely 
absent — until now. Publishing Steffie 
Woolhandler's piece in the Summer 
2004 issue of the Bulletin gave tacit 
acknowledgment of the documented, 
growing physician support for 
national health insurance. As we 
careen ever closer to a "perfect storm" 
in health care, the Har\'ard tarrdly as 
well as the public should no longer 
dismiss this as poUtical fantasy. 

JAMES BERNSTEIN '52 
ROCKVILLE CENTRE, NEW YORK 

Final Wishes 

In the speech Markella Zanni '04 
gave at graduation, as printed in 
the summer issue of the Bulletin. 
she recounted an incident in 
which her colleagues inquired, in 
reference to a patient in her late 
eighties, "Did you ask about her 
end-of-life preferences?" I believe 
that "a sensitive monologue about 
advance directives" should have 
been part of the care provided by this 
patient's primary doctor well before 
this hospitalization. Presumably the 
patient had been asked about her 
advance directives upon admission as 
required by the Patient Self- Determina- 
tion Act, so a question about code sta- 
tus would be a follow-up to the more 
basic end-of-life preferences. 



As a volunteer counselor for ad\ance 
directi\es, I know they are not just for old 
people. Linda Emanuel '84, who wrote 
"The Medical Directive," described how 
she brought up the subject with all her 
patients, assuring them that her query 
was routine and mentioning that she 
had an advance directive for herself. 

BETSY CARPENTER 

PORTOLA VALLEY, CALIFORNIA 

Torch-Borne Trilogy 

I was most fa\orably impressed by "The 
Changing Mosaic of Har\ard Medical 
School," as Eve Higginbotham '79 
described it in the summer issue of the 
Bulletin, and I applaud the efforts of HMS 
to di\'ersify its student population as well 
as its faculty and staff. I 
was also deUghted to see the 




articles on the health care financing crisis. 
I regret that the profession has not pro 
duced greater leadership in assuring a sta- 
ble and workable health care system for 
the people of this country, and I am glad to 
see the Bulletin addressing those questions. 
Parenthetically, the superb medical 
school at the University of North Carolina 
at Chapel Hill, where I am professor of 



medicine emeritus, just celebrated its 
fiftieth anni\ersar)' as a four-year school. 
It has a distinct Har\ard flavor. Reece 
Berryhill, Class of 1927, estabUshed it as 
a four-year school. He was succeeded by 
Isaac Taylor, Class of 1945, and then by me, 
a member of the Class of 1951. My succes- 
sor was Stuart Bondurant, who trained at 
the Brigham. Many of the school's faculty 
members ha\'e a Har\'ard background, 
and we can attribute some of its fantastic 
success to the Harvard legacy. 

Many thanks for the summer issue. 

CHRISTOPHER C. FORDHAM III '5I 
CHAPEL HILL, NORTH CAROLINA 

Short and Sweet 

The summer issue of the Bulletin 
includes an oath that the Class of 2004 
crafted to take the place of the one by 
Hippocrates. It is commendably ide- 
alistic but its 43 lines make it too 
long to be remembered. It begins, "I 
solemnly pledge to consecrate my life 
to the service of humanity." Such 
consecration is, in itself, a solemn 
pledge. One could simply say, "I give 
myself to the service of humanity." 

I suggest consideration of an oath 

that would be a modification of the 

"Qualities of a Physician," by Oh\'er 

W endell Hohnes, Class of 1836: "To cure 

seldom, to relieve often, and to comfort 

always." The oath would read: "I give 

myself to the service of humanity. With 

the help of nature, I will cure whene\-- 

er possible, relie\'e often, and comfort 

always. I wiU do no harm. I wiU honor 

my teachers by teaching. I wiQ work 

for peace in myself, in my family, in my 

community, and in my \vorld." 

Peace and healing cannot be 
separated in a nuclear world and 
among underinsured communities. 

GEOFFREY R. PAUL "56 

SAN FRANCISCO, CALIFORNIA 

The Bulletin welcomes letters to the editor 

Please send letters b\ mail (Harvard N ledical 
Alumni Bulletin, 25 Shattuck Street, Boston. 
Massachusetts 02115): fax (617- 384-8901); or 
email (hullctin^hms.hanxird.edu). Letters max 
be edited for length or clarity. 



HARVARD MEDICAL ALUMNI BULLETIN • WINTER 2005 



MAKING THE ROUNDS AT HMS 



PTIT.SE 




Wake-Up Call 




HRISTINE WEEKS 'O3, A SECOND- 

year surgical resident at 
Brigham and Women's Hospi 
tal, found the time to train for a 
marathon and run it in November, despite 
a busy schedule. Such a feat would ha\'e 
been difficult to imagine in the days when 
residents might spend an entire weekend 
at the hospital before going home for a few 
hours of sleep, .'\lthough Weeks and her 
fellow residents still put in an occasional 
24 -hour shift, for the most part, they work 
12 hours at a time with 12 hours off 
between shifts. "You go home every day 
like a normal person," Weeks says. 

Times are changing for medical resi- 
dents. Many residency programs have 
been cutting back hours for years now. 
And guidelines imposed in 2003 by the 
Accreditation Council for Graduate Med 
ical Education (ACGME) formalized 
those changes. Now, residents can a\'er- 
age only 80 hours per week o\'er a four- 
week period, must take a full day off per 
week and at least 10 hours off between 
shifts, and cannot work more than a 30- 
hour shift, of which the last 6 hours must 
not be de\-oted to clinical care. 

When a team led by Charles Czeisler, 
the Frank Saldino, Jr., PhD Professor 
of Sleep Medicine at Brigham and 
Women's, unveiled data showing that 
interns were more alert and made fewer 
serious errors when they worked shifts 
of 16 hours rather than the traditional 30, 
the question was once more raised of 
how severely the residents' hours should 
be cut. While the study, published in the 
October 28, 2004 issue of the New England 
journal of Medicine, was conducted before 
the ACGME guidehnes took effect, the 
control schedule it used was similar to 
the 80-hour workweek that is now man- 
dated for residents. But the new infor- 
mation comes at a time when many 
teaching hospitals are still struggling 
with the recent ACGME guidelines and 
are not prepared to take steps to reduce 
hours further. 



Road Work Ahead 




^^^^^k **W^ ^^^^^^H '^EI'ICAL INTERNS WHO WORK 

^^V^^V -*^^^^^^^x^9l extended shifts of at least 24 hours 

^^fcJW ^^^^H^^^^i °'^^ more likely to be involved in 

-,i,^^^^^ ^^^^^^^^1 niotor vehicle crashes and near 

^^^^V ^~" ^^^^^B misses, according to a study in the 

January 1 3, 2005 issue of the 

h^^^^^_ ^^^^^^^^^^ New England Journal of Medicine. 

_^^^m^^^^^^^ _^^^^^^^^HH This evidence adds fuel to 

^_ M iJ^^ li^^^^^^^^^^^^ the debate over resident hours. 

The study was conducted by 
the Harvard Work Hours, Health, 
and Safety Group, headed by 
Charles Czeisler at Brigham and 
Women's Hospital. The researchers 
conducted a prospective. Web- 
based survey of 2,737 interns across the country. "From that analysis," Czeisler 
says, "we found that for each extended-duration shift they work per month, there 
was a 16 percent increase in the monthly risk of a motor vehicle crash driving 
home from work, and they could be scheduled for as many as ten extended shifts 
per month by current guidelines." 

The research team for this study, led by Laura Barger, HMS clinical fellow in medi- 
cine at Brigham and Women's, also examined whether each subject was more likely to 
experience an incident on the road after an extended shift. The analysis showed that 
interns had more than double the odds of having a motor vehicle accident on the com- 
mute home from an extended shift and more than five times the odds of having a near 
miss than they did after working a shift of 1 2 hours or fewer. 

"The ACGME is the only nationally recognized regulatory body of any kind that 
continues to sanction 30-hour shifts," Czeisler says. "Unfortunately, this establishes 
as a national standard a practice that endangers these trainees as they drive home 
from work." ■ 



Keeping residents more alert by ensur- 
ing they have adequate sleep seems like a 
no-brainer, but in fact it raises concerns 
among many physicians that the change 
to shorter shifts may ultimately harm 
patient care. The greatest worry is that 
shorter shifts will cause errors as patients 
are handed from one doctor to another, 
interrupting the continuity of care. 

According to Michael Freed, director 
of graduate medical education at Chil- 
dren's Hospital, residency programs have 
been moving toward more reasonable 



hours for years, but now it is happening in 
the context of stricter educational stan- 
dards and increased financial pressures. 
"There are educational rec[ULrements that 
are getting tightened up by the residency 
training committees of the ACGME while 
they are tightening hours," he says. 
"Medicare is also tightening funding for 
residents. The hospitals ha\'e to sort out 
all these competing interests." ■ 



Courtney Humphries 
for Focus. 



IS a science writer 



WINTER 2005 • HARVARD MEDICAL ALUMNI BULLETIN 



ptit.sk 



MAKING THE ROUNDS AT HMS 



The Illusive Art of Teaching 




HARVARD MEDICAL SCHOOL'S EFFORTS TO 

integrate medical simulation into the 
educational process were showcased in 
a Classroom of the Future exhibit in 
November. More than 200 attendees from 
the Council for Harvard Medicine, the 13- 
School Consortium (a group of major 
research' centered medical schools), and 
the Association of American Medical Col- 
leges (AAMC) participated in the exhibit 
as if they were medical students, taking 
part in hands-on learning VkTth an array of 
innovative educational technologies. 

The case of the day was asthma. The 
setup, a blend of a traditional tutorial 
room and simulator laboratory, featured 
the usual HMS classroom technology, 
including a Web-enabled display moni- 
tor, along with a hospital bed and patient 
simulator placed alongside a tutorial con- 
ference table and chairs. The electronic 
patient displayed symptoms, complaining 
to the "doctors" about shortness of breath. 

Participants had to na\Tgate an entire 
care episode, conducting a real-time 
LQterview and exam, considering differ- 
ential diagnoses and test results, institut- 
ing a treatment plan, and communicating 
with the patient and other providers. 
They then turned to the traditional class- 



room and discussed aspects of the case, 
exploring relevant sciences down to the 
cellular and molecular mechanisms. The 
educational platform MyCourses animat- 
ed material on the large-screen displays, 
including annotated diagrams, radiog- 
raphy, virtual microscopy, and gross 
anatomical specimens. 

"In this integrated setting, we can gi\'e 
students a lesson in asthma by incorpo- 
rating basic and clinical sciences as a uni- 
fied whole," said James Gordon, HMS 
assistant professor of medicine at Massa- 
chusetts General Hospital and director of 
the G. S. Beckvidth Gilbert and Katharine 
S. Gilbert Medical Education Program in 
Medical Simulation. "Here, the tradition- 
al tutorial is enhanced by a customized 
bedside encounter and complemented by 
the resources of the digital world — all in 
a single learning space." 

Likening medical simulation for stu- 
dents to flight simulation for pilots, 
Nancy Oriol 79, HMS dean for students, 
said that the Classroom of the Future 



allows for a safe, "practice-makes-per- 
fect" environment. "Students can work 
on clinical judgment, communication, 
and action skills as often as needed," 
Oriol said. "Adding the 'hands-on' care 
makes the learning indelible. And 
instead of relying on chance encounters 
with patients to teach students about 
particular diagnoses, the Classroom of 
the Future allows the students to expe- 
rience a range of clinical cases across 
age, culture, and gender." 

"From an educational standpoint, we 
would like all medical students to have 
meaningful experiences that represent 
the full spectrum of medicine," Gordon 
said. "But we cannot guarantee that 
every student will care for someone 
with severe asthma, for example. Now, 
with the simulator, students can see 
virtually any patient in the curriculum, 
on demand." ■ 

Leah Gourky is a former editorial assistant 
with Focus. 




MODEL PATIENT: Above: James Gordon (center), HMS assistant professor of 
medicine, instructs students (clockwise from lo>ver left) Sarah Kempe-Mehl, 
Karimi Gituma, David Lee, and Henry Delu as they vt^ork with a simulated 
patient. Above left: Nancy Oriol (center), HMS dean for students, and students 
Wally Bethune (left) and Ben White demonstrate use of the simulated patient. 



HARVARD MEDICAL ALUMNI BULLETIN • WINTER 2005 



PRESTDENT\S REPO 



Against All Odds 



Q 



HIS ACADEMIC YEAR HAS BEEN FILLED WITH TRANSI- 

tions for HMS. The School's financial constraints, 
for example, led to staff cuts and offers to senior 
administrators to take early retirement. Sadly 
for us, one of those retirees was Nora Nercessian, 
associate dean for alumni programs and special projects. 

Nora deserx'cs much of the credit for organizing and lead- 
ing the School's alumni office during her 17-year tenure. She 
left on a high note with the publication of her most recent 
work. Against All Odds: The Legacy of Students of African Descent 
at Harvard Medical School Before Affirmative Action, 1850-1968. 
In the book, Nora presents profiles of 85 students of 
African descent dating back to the first matriculants. 
Her fascinating, well-received account is now available 
online (www.hms.harvard.edu/dcp/againstallodds). 

To celebrate the manuscript's publication, Joseph Mar- 
tin, dean of HMS, and Joan Reede, the School's dean for 



In closing the day's events, Joan Reede extended her grat- 
itude to those who came to HMS before her, for their 
courage, sacrifice, and perseverance. "It is because of you that 
people like me can stand here today," she said. "We stand on 
your shoulders. The challenge for all of us is to find ways to 
continue to \\'ork together to make the past that has led to 
where we see ourselves today inform the future." 

Nora's last official act was to coordinate the relocation of 
the .\lumni Office from Gordon Hall to spacious new quarters 
in the Landmark Center on Park Drive (the old Sears Build- 
ing). Reunion planning and all alumni office functions will be 
carried out from this location. Sharing space with the Alumni 
Fund, the Office of Resource Development, and the Bulletin 
in this new location will help build closer relationships and 
encourage collaborative opportunities, energies, and ideas. 

Patrick Rivera, who worked closely with Nora for sever- 
al years, has assumed leadership of the office. We congrat- 




"f "The memories of living alumni of African 

descent include some painful experiences, but 
the outcomes are cause for celebration." 



diversity and community partner.ship, hosted a Diversity 
Town Forum and celebration. Many African American 
alumni honored us by returning for the occasion, marking 
it as a significant event in the School's history. Mildred 
Jefferson '51, the first female graduate of African descent, 
attended, as did a dozen other alumni featured in Nora's 
work and relati\es and descendants of six others. 

In their preface to the book. Dean Martin and Daniel 
Federman '53 wrote, "The effort to prepare a complete 
record of the .\frican American presence at HMS is com- 
plemented by autobiographical contributions from li\ing 
alumni. Their memories include some painful experiences, 
but the outcomes are cause for celebration." 

Gloria Still, a descendant of James Thomas Still — who 
entered HMS in 1867 and was the third verified student of 
African descent to graduate from HMS — attended the events 
with three other Still relatives. "To me," she told those assem- 
bled for the celebratory dinner, "the important story is that 
young people understand that e\'en in the midst of what I call 
modern-day slavery — whether it's drugs, alcohol, or under- 
education — the whole story of our family is that people, in 
spite of ad\'ersity, can be free, can be successful, and can soar." 



ulate him upon his promotion to assistant director of alum- 
ni relations and look forward to working with him. 

Finally, we have had to accept the fact that Dan Feder- 
man wishes to step down as director of alumni relations. 
Dan has performed magnificent work as director for the 
past 12 years — ^just as he has done in all the roles he has 
played on behalf of the School over the past five decades. 
We hope to continue to benefit from his broad knowledge 
of the alumni, his skill as a fundraiser, and his wise counsel 
well into the future. Search committee members appointed 
by the dean and the Alumni Council will announce his 
successor in the spring. 

Despite the challenges such transitions pose, the Coun- 
cil's work persists. We continue, for example, the focus on 
student indebtedness that the past Council president. 
Eve Higginbotham '79, initiated last year. The Council has 
authorized a subcommittee to investigate innovative pro- 
grams that will benefit students, and Council members 
will be developing a proposal over the next year or two. ■ 

Joseph K. Hurd,jr '64 is chairman of the Dcpcu-tment of Gynecology at 
the Lahey Clinic Medical Center m Burlington, Massachusetts. 



WINTER 2005 • HARVARD MEDICAL ALUMNI BULLETIN 



BOOKMARK 



I REVIEWING THE PRINTED WORD 



Escape Fire 



Designs/or the Fiiiwx oj Health Care 

by Donald M. Berwick 72 (josscy-Bass, 2004) 

IT IS NOT HARD TO FALL IN LOVE WITH A STRANGER. IT IS MORE 

arduous, though not impossible, to fall in love with a stranger 
who is a sobcrminded, bespectacled expert in decision 
analysis and technology assessment — a scholar, physician, 
husband, and father of four. Nonetheless, I begin with bias: 
I am in love with someone I have never met, who is himself 
in love with. ..Quality Improvement. 

Quality Impro\'ement. The words e\'oke the memory of a 
roomful of annoyed colleagues. We have 
received our biannual QI assignments, 
proofs of intention for hospital re -accredi- 
tation. Dutifully, resentfully, we rexaew the 
charts of paper patients. Are the AIMS 
examinations up to date? Were pain scale 
measurements done pre- and post -Tylenol 
administration? Results are collated into a 
bar graph. There is a pointed finger or two, 
which are tossed into a pit filled v,Tth 
other accusing fingers pointing in a dozen 
different directions, and we are free from 
QI for another six months. 

Then I fell in love with the stranger, 
or at least, with his thinking. Escape Fire: 
Designs for the Future of Health Care, by 
Donald Berwick 72, collects a decade 
of speeches he gave at the Institute for 
Healthcare Improvement's armual forum 
about "this nearly derailed, perilously 
wandering health care industry." The forum began in 1989 
with not even 300 attendees, whom Berwick calls, "hardy 
souls — a fringe element." By 2002, the fringe had gro\\Ti to 
3,500, all weary of an industry filled with "nonsensical, aim- 
less, enervating restructuring, accusation, surveillance, and 
blame" (translation: the Fingers). Instead, Berwick offers a 
system of care that would be "better, cheaper, and inciden- 
tally more satisfying to work within." He does it with such 
drama, factual assurance and, when necessary, flagrant silli- 
ness, that only an idiot would not sign on the dotted line. 

These speeches make the best kind of essays — readable and 
thinkable. Each forms around a core of some list related to 
quahty improvement. They are like a Christmas carol: ele\'en 
strategies to improve performance, ten elements of world- 
class health care, six ideas for change, fi\'e preconditions, four 
attributes of spread. This is a cle\'er strategy. Lists make the 
unmanageable seem manageable and the inconcei\'able possi- 
ble. They boil years of experience and proof-by-trial into four- 
word phrases. Add a tune and you start to sing along. 




Most of the goals seem so sensible it's hard to fathom why 
we haven't reached them. Maybe it's because until now no 
one has listed them so cogently: eliminate unnecessary' 
admissions, tests, and treatments; streamhne drug use; 
decrease waiting time and in\'entor)' levels; record — and 
request — information only once; measure aims over time; 
and measure for impro\ement, not judgment. Underneath 
them all, the unifying goal — and the one most difficult to put 
into practice — is cooperation. "I want us more than amthing 
else to help each other," Berwick wTites. It's this simple wish, 
slipped naked between statistics and technical terms, that 
gives e\'erything he writes such passion. 

Cooperation: a \isionary idea. The status quo these days is 
desolation. Flawed medical delivery is the 
personal story we all tell e\entually. Your 
medical specialty wiU not sa\"e your broth- 
er from dehumanizing care at the end of his 
hfe, and it will not save you, either, when 
you become a patient. Berwick's own dis- 
tinguished career did not save his father 
(also a physician) from one hunuliation 
after another when he deteriorated from 
Parkinson's disease and a hip fracture. It 
did not sa\'e Berwick's wife from one dan- 
gerous inefficiency after another when 
she fell ill with myelitis. The experience, 
he describes, "was often one of trying to 
get the attention of decision -makers to cor- 
rect their.. .as.sumptions," 

Berwick wants, more than anything else, 
for us to help each other. But stor)' after 
stor)' makes help seem hopelessly far away. 
On ever}' le\'el, it is grim. Yet Berwick is also 
a behe\'er, with statistics to back his optimism. Competition is 
motivating, but so is what he calls "the performance of systems 
of interdependency" He can pro\e it. Signs of promise for med- 
icine — inspiring, effecti\'e, sometimes highly amusing signs — 
emerge in fields as nonmedical as car manufacturing, elemen- 
tary school soccer coaching, and smokejumping. 

But change can be fueled only by constant reminders of 
ultimate purpose. We are human, we instruments of change, 
and in the end, self-interest wiU improve care deli\'ery: you 
owe it to your father, your spouse, your child, and ine\itably, 
yourself. "We have studied enough," Berwick writes. "\\'e 
know how. Now we must remember why." 

In one of the last speeches in the book, Berwick teases him- 
self by adding, "You will say that I overinvest my hopes in 
intrinsic human motives." But this is not overinvestment. This 
is high, clear vision: using gifts of the mind to honor the soul. ■ 

Elissa Ely '88 is a psychiatrist at the Massachusetts Mental Health 
Center and the Boston Health Care for the Homeless Program 



HARVARD MEDICAL ALUMNI BULLETIN • WINTER 2005 



BOOKS BY OUR ALUMNI 



ROOKSHET.F 1^3 




MICHIIEl 



STITEi'FEAR 




The Last Well Person 

Haw (0 Sta\ W cU Despite the Health Care 
System, by Xortin M. Hadler "68 
(McGillQiiccns University Press, 2004) 

Hadler, a rheumatologist and professor 
of medicine and microbiology immunol- 
ogy at the University of North Carolina 
at Chapel Hill, believes Americans ha\e 
given too much power to medicine and 
lack faith in their owti abilities to stay 
well. He critiques the tendency to turn 
normal physical distress into illness and 
questions the efficacy of many expen- 
sive procedures, including mammogra- 
phy and cardiac bypass surgery. Staying 
well, he contends, means being able to 
cope with life's una\oidable challenges. 

Carousel Music 

by Rick Mosko\itz 73 (Infinity 2004) 



In this novel, psychotherapist Kenneth 
Miller has been treating Stephanie 
W'hittington for borderline personality 
disorder for years before she remembers 
a childhood filled with terror at her 
father's hands. Her father claims Miller 
planted false memories and files a law- 
suit that drags two families through the 
courts and toward some hard truths. 



State of Fear 

by Michael Crichton '69 
(Harper Collins, 2004) 

Scientists, lawyers, and environmental 
ists square off in this thriller. Murder 
and fraud committed across the globe 



are tied to a fictional environmental 
group and their extremist agenda. 
Crichton tackles the controversies sur- 
rounding climate change, taking readers 
from the glaciers of Antarctica to the 
jungles of the Solomon Islands. 



Massachusetts General 
Hospital Handbook of General 
Hospital Psychiatry 

by Theodore A. Stern, Gregory L. 
Fricchione, Ned H. Cassem '66, 
Michael S. Jellinek, andjerrold F. 
Rosenbaum (5th edition; Mosby, 2004) 



This book offers a comprehensive guide 
to diagnosing and treating psychiatric 
patients. It includes behavioral and cog- 
nitive strategies for managing adults 
and children coping with depression, 
anxiety, delirium, chronic disease, and 
more. Twenty new chapters provide 
updates on psychopharmacology and 
discuss key issues in geriatric care, 
hypnosis, and alternative medicine. 

Powerful Medicines 

The Benefits, Risks, and Costs of Prescription 
Drugs, by Jerry Avorn '73 (Knopf 2004) 

Avorn, an associate professor of medicine 
at HMS and chief of the Di\1sion of Phar 
macoepidemiology and Pharmacoeco- 
nomics at Brigham and Women's Hospi- 
tal, reminds readers that every pill we 
take — or prescribe — represents a com- 
promise between potential healing, risky 
side eEects, and a daunting price. He 
offers an insider's view of a future that 



BETTER 
HEALTH CARE 



AT HALF THE COST 



.KNOT VON HIPPEL. M.O- 




includes patient choice, computer- 
assisted prescribing, and policies that 
combine the best of conservative and 
liberal insights. 

Better Health Care at Half the Cost 

by Arndt \bn Hippel '57 (Von Hippcl, 2004) 



Von Hippel, a long-time surgeon in 
Alaska, contrasts the original impact, 
availability, and low cost of penicillin 
with the high prices garnered for 
today's new medications, arguing that 
the pharmaceutical industry's political 
clout has hurt health care. He advocates 
for more research into simple, inexpen- 
sive remedies; a shorter term on drug 
patents; and above all, a single-payer 
system. Packed with anecdotes, data, 
and suggestions, this book is both con 
versational and provocative. 

What Are Old People For? 

How Elders Will Save the Worli 
by William H. Thomas '86 
(VanderWyk c- Bumham, 2004) 



Thomas, a geriatrician, wants to change 
the per\'asive "decHnist" view that aging 
equals loss, which results from measuring 
"elderhood" with the same yardstick used 
for adulthood. Elderhood, he says, is a time 
when emotional functioning improves 
and people rehsh diversity, become less 
self-centered and more altruistic, and 
increase their powers of adaptation. In 
upstate New York, Thomas founded the 
first "Green House" — a group home that 
embraces the elderly and provides an 
alternati\'e to institutional care facilities. ■ 



WINTER 2005 • HARVARD MEDICAL ALUMNI BULLETIN 



HMAHKS 




DISCOVERY AT HMS 



Hair-Raising Possibilities 



FROM THE BEGINNING OF RECORDED 

history, humanity has engaged in a 
frenzied quest to regrow hair where 
it once adorned men's scalps. 
Hippocrates, the legend goes, 
favored a topical ointment con- 
taining such ingredients as opium, 
horseradish, pigeon excrement, 
beetroot, cumin, and nettles. The 
concoction didn't work, and to 
this day, the father of medicine is 
known not only for the oath all 
new doctors swear, but also for 



which could have enormous implica- 
tions for the treatment of hearing and 
balance disorders," says the study's 
senior author, Zheng- Yi Chen of the 
MGH Neurology Service. "They also 
show that cells that have been consid- 
ered incapable of regeneration — Uke 
most nerve cells — can reproduce 
under the right conditions, which may 
have applications to neurodegenera- 
tive diseases." 

Named for the hair-like projections 
on their surfaces, hair cells form a rib- 



"These findings give us a potential strategy for hair cell 
regeneration, which could have enormous implication^ 

fnr tnf> trt^atmt^nX rtf nf anna ann oalanCC dlSOrdcrS. Tr^ 

iidered incapa 
I right conditions. 



"Hippocratic baldness," as extreme 
cases are sometimes dubbed. Recent- 
ly, however, researchers may have 
made a revolutionary breakthrough 
in the science of hair regeneration 
in the hope of curing not baldness 
but deafness. 
Researchers at Massachusetts 
General Hospital (MGH) have found 
that selectively turning off a protein 
that controls the growth and division 
of cells could allow regeneration of the 
inner ear's hair cells, which convert 
sound vibrations into nerve impulses. 
The discovery runs counter to current 
beliefs about these cells and could 
eventually lead to ways of preventing 
or treating hearing loss. The report 
appears in the February 18, 2005 issue 
of Science. 

"These findings give us a potential 
strategy for hair cell regeneration. 



bon of vibration sensors along the 
length of the cochlea, the organ of the 
inner ear that senses sound. Receiving 
sonic vibrations through the eardrum 
and bones of the middle ear, hair cells 
com'crt them to electrical signals that 
are carried to the brain by the auditory 
nerve. Among the earliest structures to 
form in embryonic development, hair 
cells are highly sensitive to damage 
from excessive noise, infections, and 
toxins, including some medications. 
Once damaged, hair cells do not natu- 
rally regenerate in mammals, and their 
death accounts for most types of 
acquired hearing loss. 

Many proteins have been identified 
as controllers of the different cell cycle 
phases. Chen's group started by carry- 
ing out a comprehensive assessment 
of which genes are active in the devel- 
oping mouse ear and when they are 



HARVARD MEDICAL ALUMNI BULLETIN • WINTER 2005 




expressed. The activity of certain 
genes suggested that the retinoblas- 
toma (Rb) protein, known to sup- 
press the cell cycle, could be impor- 
tant for halting the cell cycle in hair 
cells. The researchers then used a 
genetically modified mouse strain 
in which Rb was no longer made in 
the inner ear. 

The investigators found that hair 
cells in the ears of these mice were 
significantly more numerous than 
in normal mice at the same stage of 
development. These additional cells 
retained the distinctive appearance 
of hair cells, performed functions 
characteristic of normal hair cells, 
and appeared fully able to form 
proper connections with nerve 
cells. In addition, hair cells in the 
modified mice made proteins that 
indicated they were still acti\'ely 
regenerating, while cells in normal 
animals did not. 

The re-scarchcrs note that these 
findings will form the basis for 
future work aimed at recovery of 
hearing through hair cell regenera- 
tion. In particular, they have to 
learn to control the presence of Rb 
for short times, allowing some 
regeneration but not too much. The 
genetic basis of hearing and deaf- 
ness is almost identical in mice and 
in humans, so a successful mouse 
model may ultimately translate into 
therapy in human patients. 

"It's taken over ten years of work 
to show that hair cells can regener- 
ate in tissues, and I hope it won't 
take another decade to achieve 
functional regeneration in a living 
animal," says Chen, an HMS assis- 
tant professor of neurology. "But my 
hope and belief is that, if we can do 
this in mice, we'll be able to achie\'e 
it in people." ■ 



Lethal Forces 



ALE DOCTORS TAKE THEIR 

own lives at a higher 
rate than the general 
population of white men 
in the United States. That's been 
known for some time. Now, the lat- 
est national study of physician sui- 
cide has found that female doctors 
take their lives even more often. 

HMS researchers undertook the 
study following the suicide of a 
female medical student at Harvard. 
Eva Schernhammer and Graham 
Colditz examined the results of 25 
studies of physician suicide and con- 
cluded that male doctors killed them- 
selves at a rate 41 percent higher 
than that of other men and women. 
The more startling finding was that 
female doctors take their lives at a 
rote more than twice (2.27 times) 
that of the general public. 

"We do not yet have a clear 
answer to why this is," admits Sch- 
ernhammer, who works at Brighom 
and Women's Hospital. "There is 
evidence that depression, drug 
abuse, and alcoholism, possibly 
related to stress, are often associat- 
ed with physician suicide. Female 
physicians in particular have been 
shown to have a higher frequency 
of alcoholism than women in the 
general population." 

Women may feel more stress 
because of gender bios and on 
increased need to succeed in the 
mole-dominated medical profession. 
That seems likely, Schernhammer 
soys, but there have been no conclu- 
sive studies to back it up. She also 
notes that being single and not hav- 
ing children — which is more com- 
mon among women than men in 
medicine — "has been linked to high- 
er suicide rates." 

The researchers published the 
results of their investigation in the 
December 2004 issue of the /Ameri- 
can Journal of Psychiatry. In this 
report, they cite evidence from other 
studies that doctors who kill them- 
selves "ore more critical of others 




and of themselves, and ore more 
likely to blame themselves for their 
own illnesses." 

Other studies conclude that doctors 
feel uncomfortable turning to their col- 
leagues for help. Instead, they may 
"resort to alcohol or drugs and isola- 
tion. Once they seek help, it appears 
likely they ore not taken seriously 
enough by their fellow colleagues." 
One investigation found that more than 
half of physicians who sought help 
later took their lives. Although they 
had oil been diagnosed with psychi- 
atric problems, none of them hod been 
hospitalized before committing suicide. 

Schernhammer and Colditz believe 
that the underlying risk factors for 
female physicians' suicide — such as 
depression and psychiatric disor- 
ders — could moke them logical candi- 
dates for prevention programs. 

The researchers recommend that 
the higher risk of suicide among 
physicians, particularly female physi- 
cians, be recognized nationally. They 
suggest that more studies be conduct- 
ed to determine the causes of the sui- 
cides and to find ways to prevent 
them. And, Schernhammer odds, "an 
open discussion of the stress encoun- 
tered in medical careers is critical for 
successful early recognition of impair- 
ment and risk of suicide." ■ 



William Cromie is a writer for the 

Harvard Gazette. 



WINTER 2005 • HARVARD MEDICAL ALUMNI BULLETIN 



11 



RKNCHMAHKS 



DISCOVERY AT HMS 




Threading the Maze 



ONFRONTED WITH A NEW 

construction project on a 
normally clear street, the 
average driver will detour 
around the traffic jam or plot a differ- 
ent route for the next day's commute. 

In de\'ising this strategy, one region of 
the brain seems to take charge of sensing 
setbacks and switching to a new course 
of action. The findings, the first direct 
human evidence of this localized func- 
tion, are reported in the December 2004 
issue of Nature Ncurosckncc by a group 
of neurosurgeons and psychiatrists at 
Massachusetts General Hospital. 

The findings come from neuronal 
recordings of five people who con- 
sented to take a few minutes during 
delicate surgery on their brains to 
move a joystick to the left or right in 
response to simple commands on a 
computer screen. For the experiment, 
"$$$$$" flashed on the screen every 
time patients correctly moved the joy- 
stick, rewarding them the highest 
prize (15 cents) and telling them to 
repeat the same move. A double arrow, 
"<>," indicated a direction change to 
win the same top prize. Occasionally, 
"$$$" would pop up, yielding a 
reduced reward (9 cents) and telling 
the subjects to change direction for 
the higher incentive. 

The patients performed the tasks 
before and after a rare procedure called 
a cingulotomy. The operation had no 
relationship to the experiment except 
that, with the patients' consent, it 
afforded access to a specific region of the 
brain and a chance for direct evidence 
of the region's function. A cingulotomy 
ablates the tiny area known as the dor 
sal anterior cingulate cortex. The same 
thin microelectrodes that helped Ziv 
Williams, HMS clinical fellow in 
surgery, and Emad Eskandar, HMS 
assistant professor of surgery, precisely 
define the surgical site also recorded 
the activity of individual neurons dur 
ing the brief experiments. 



The surgery is a last-ditch effort to 
treat severe depression, obsessive-corn 
pulsi\'e disorder, and bipolar affective 
disorder when all else seems to have 
failed. Even in these cases, the problem 
likely resides not in the cingulate, which 
the study authors beheve to be compar- 
atively normal in these patients. Instead, 
the surgical lesion may disrupt a nearby 
circuit, leading to gradual chnical bene- 
fits three to six months later, presum 
ably emerging as the brain adapts, said 
co-author Scott Rauch, HMS associate 
professor of psychiatry. 

Of the total 134 neurons recorded 
across the five patients, about one- 
third reacted to the direction change 
signals. Most of these were stimulated 



by the $SS reduced-reward cue. Inter- 
estingly, the neurons began firing 
about three seconds before anyone 
mo\ed the joystick, predicting when 
people would correctly change direc- 
tion after seeing SSS, said XVUliams, 
first author of the paper. 

Other convincing e\idence that 
these neurons are important to this 
error-monitoring behavior came from 
data collected after the cingulotomy. 
Patients showed a dramatic reduction 
in changing joystick direction in 
response to the SSS signal, compared to 
prompts by the neutral <>. There was no 
change with SSSSS. 

"That tells us they were impaired in 
their capacity to percei\'e the reduced 




12 



HARVARD MEDICAL ALUMNI BULLETIN • WINTER 2005 



-f - ' 



reward and to change behavior 
accordingly," says Eskandar, the senior 
author. "Somehow, the cingulate is 
important in telling a person that a 
previously fruitful or productive activ 
ity is now less so. It may be the part 
of the brain that tells you something 
is not working anymore and it's time 
to try something new." 

The findings add a new layer of e\i- 
dence to earUer nonin\'asi\'e imaging 
studies, which ha\'e impHcated this part 
of the cingulate in detecting errors, 
monitoring personal conflicts, and per- 
forming new beha\ior. 

Eskandar and his colleagues also 
have applied their pioneering intra 
operative recording techniques to 
explore the pathology behind Parkin- 
son's disease. In the December 15, 2004 
issue of The ]om-na\ of 'Scuroscimcc, they 
report how an experimental task 
briefly disrupts the pathological sig- 
nals in the diseased area of the brain. 

The Parkinson's study took place in 
the midst of a therapeutic procedure 
to implant an adjustable electrode to 
reduce or modify the abnormal neu- 
ronal activity underlying the disease. 
When the 11 consenting patients used 
a joystick to guide a green dot to its 
target on a computer screen, the char- 
acteristic abnormal electrical bursts in 
the dopamine star\ed cells of the sub- 
thalamic nucleus took on a more nor- 
mal firing rate. The study was led by 
Ramin Amirnovin, HMS clinical fel- 
low in surgery. 

One limitation of the studies is the 
likely stressful surgical setting. "It's a 
complicated process," Williams says. 
"We don't presume to know how peo- 
ple are able to make strategic deci- 
sions, but we think this area of the 
cingulate plays a significant role in 
linking those two parts of the world, 
perception and action." ■ 

Carol Cruzan Morton is a science writer 
at Focus. 








RNRx 




Since 1976, the Nurses' Health 
Study — conducted at the Chan- 
ning Laboratory at Brighom and 
Women's Hospital — has helped 
identify important risks in women's 
health. The following studies offer 
additional findings: 



11114^ WEIGHTY EVIDENCE 

Researchers have found more evidence that weight plays a key role in 
breast cancer survival. The study, appearing in the January 31, 2005 online 
issue of the Journal of Clinical Oncology, finds that women who maintain a 
healthy weight before diagnosis and avoid weight gain after treatment may 
hove improved survival rotes compared with women who ore overweight or 
obese prior to diagnosis or who ore lean and gain weight after diagnosis. 
"It is widely recognized that postmenopausal women who ore overweight 
face greater risk of developing breast cancer," soys lead author Candyce 
Kroenke. "This large study of more than 5,000 women shows that avoiding 
weight gain may be important to survival once a woman is diagnosed." 

\\\0- FEAR FACTOR 

Researchers hove noted that high levels of phobic anxiety hove been associat- 
ed with elevated risks of coronary heart disease (CHD) death and sudden car- 
diac death (SCD) among men — yet no such association has been investigated 
among women. Researchers at Brigham and Women's Hospital and Massa- 
chusetts General Hospital, in an analysis of Nurses' Health Study data, found 
that women who experienced phobic anxiety — such as the fear of crowded 
places, heights, or of venturing outside — were more likely to experience SCD 
or CHD than women who did not. Their findings appear in the February 2005 
issue of Circulation. 

According to lead author Christine Albert, "Physicians probably should 
consider that women who suffer from phobic anxieties are at elevated risk 
of death from heart disease and should, at the very least, try to control their 
other potential heart disease risk factors." Phobic anxiety is twice as preva- 
lent among women than among men. 

m^ TEMPERING TEMPERANCE 

The adverse effects of excess alcohol consumption are well established, yet the 
health effects of moderate consumption — one drink of wine, beer, or liquor — 
ore not clear. Researchers found that compared with women who were non- 
drinkers, older women who consumed one drink per day experienced a 
20 percent reduced risk of cognitive impairment. These findings appear in 
the January 20, 2005 issue of the New England Journal of Medicine. 

"Much evidence has demonstrated the heart benefits of light alcohol drink- 
ing, but less research has focused on cognitive functioning," says senior 
author Francine Grodstein. "While we all continue to recommend exercising 
caution when consuming any type of alcohol, our study suggests that moder- 
ate consumption might provide older women with some cognitive benefits. 
Additional research needs to be conducted to understand the links." 



WINTER 2005 • HARVARD MEDICAL ALUMNI BULLETIN 



Harvard Medical Schoo 
students of African descent 
inherit a legacy that predates 
the advent of affirmative action 
by more than a century. 




THE COLOR BARRIER 



at Harvard Medical School finally broke in the fall of 
1850, the city of Boston was already in the grip of a 
race-related drama. That controversy had begun in 
stealth more than a thousand miles to the south, 
where William and Ellen Craft had hatched an inge- 
nious ruse to escape their slave owners. The light- 
skinned Ellen disguised herself as a sickly white 
man whose faithful slave, William, was accompany- 
ing his master north for medical treatment. Ellen cut 
her hair short, altered her gait, and swaddled her jaw 
in bandages to mask her lack of facial hair. To hide 
her illiteracy, she kept her right arm in a sling, which 
furnished her with a credible excuse for being unable 
to sign any papers. 

Interview by EVE HiGGINBOTHAM 



-1 



Hf 





THE GREATEST STORY NEVER TOLD: For Eve 
Higginbotham (far top corner, left) — and for 
the HMS community at large — the research 
of Nora Nercessian (far top corner, right) has 
shineci an overdue spotlight on such trail- 
blazers as, below, from left, Lewis Hoyden, 
Mildred Jefferson, and Hildrus Poindexter. 




hen I asked around, the responses were vagu( 
students of African descent had attended HM: 



Their journey eventually took the runaway slaves to 
Boston, where they found safe haven. But when word of 
their new life trickled back to Georgia, their former 
owners dispatched two slave hunters to recapture the 
Crafts. The Fugiti\'e Slave Act had recently become law, 
threatening heavy fines and e\'en jail 
time for pohce and pri\'ate citizens 
who failed to help catch runaways. 
The arrival of the slave hunters 
threw Boston into turmoil. 

Several days earlier, a series of 
events that would send Harvard 
Medical School into its own tur- 
moil had begun quietly as well, in 
the form of a letter to the dean. 
Oliver Wendell Holmes, Class of 
1836, received first one, then a sec- 
ond petition, to admit two men 
of African descent to the School. 
With the controversy over the Crafts raging in the 
city, the faculty voted to admit Daniel Laing, Jr., and 
Isaac Snowden. 

Shortly after their vote — and just two weeks after 
the Crafts had safely boarded a ship bound for 
England — a third applicant of African descent, Martin 
Robison Delany, appeared in the dean's office. By the 
end of the meeting. Holmes had accepted the young 
man s petition for admission. 




OPTIMAL ILLUSION: To escape her 
slaveo'wner, Ellen Craft posed as 
a sickly >vhite man traveling 
north v/ith his faithful slave — in 
reality, Ellen's husband, William. 



But before the winter term was halfway completed, 
the presence of the three students of African descent 
caused the School to erupt in controversy. A handful of 
medical students had begun a campaign to oppose the 
admission of a female applicant — Harriot Kezia Hunt — 
and to expel the students of African 
descent. Despite the support of most 
of the students for their classmates of 
African descent, the campaign ended 
with Hunt's appUcation refused and 
the three men expelled. 

The stories of Laing, Snowden, 
and Delany — and the history of 
other matriculants of .African 
descent at HMS before affirmative 
action — unfold in a book recently 
issued by the School, Against All Odds: 
The Legacy of Students of African Descent 
at Hanwd Medical School Before Affinna- 
live Action, 1S50-1968. Eve Higginbotham '79 inter\iewed 
the book's author, Nora Nercessian, now the retired 
associate dean for alumni programs and special projects 
at HMS, to learn more. 

Higginbotham: What inspired \ou to write the book^ 

Nercessian: Well, for a good many years reporters, 
government officials, and historians had been calling me 



I /OA Harvard Medical 
School is founded in the base- 
ment of Harvard Hall in Cam- 
bridge, vvith three professors 
presiding over two students. 
Their teaching tools include a 
microscope, a human skeleton, 
, I and a set of 

human veins 
and arteries 
pumped up 
with wax. 





loo 7 Bertrand Fran(;ois 
Bugard may hove become the 
first HMS graduate of African 
descent, according to informa- 
tion uncovered in Nora 
Nercessian's Against All Odds: 
The Legacy of Students of 
African Descent at Harvard 
Medical School Before Affirma- 
tive Action, 1 850- 1 968. The 
clues, although compelling, 
have not been confirmed. 



I OOU Three men of African 
descent — Daniel Laing, Jr.; 
Isaac Snowden; and Martin 
Robison Delany, the "Father of 
Black Nationalism" — petition to 
take lectures at HMS. A small 
but vocal group of HMS stu- 
dents protest, complaining that 
they will not be identified as 
peers "with blacks whose com- 
pany we would not keep in 
the streets, and whose society 



as associates we would not tol- 
erate in our houses." The facul- 
ty refuses to succumb to the stu- 
dent pressure, and the three 
men, who have already bought 
tickets to the lectures, are allowed 
to attend. But on December 26, 
the faculty reverses its vote, 
and the three black pioneers 
are barred from continuing 
their medical studies offer the 
first semester. 



16 



HARVARD MEDICAL ALUMNI BULLETIN • WINTER 2005 



Maybe ten, at best twenty, 
before affirmative action. 



with the same set of questions; When did Harvard Med- 
ical School admit the first student of African descent? 
Who was that first graduate? And how many such stu 
dents had matriculated before affirmati\'e action? 

At first I had no answers. When I asked around, the 
responses were vague. Maybe ten, at best twenty, stu- 
dents of African descent had attended HMS before affir 
mative action, for example. Of course, that's not the kind 
of answer you gi\'e reporters or government officials or 
historians and expect to be taken seriously. I knew those 
questions could only be answered through research. 

As I delved, one name after another emerged, then 
archival materials and newspapers turned those 
names into people. Eventually the material amounted 
to a catalogue of spectacular achievements by heroic 
people who simply wanted to be the best doctors 
they could be. 

I had originally intended to record only a list of peo 
pie and graduation dates. But as I dug deeper, I had to 
make a decision. I could toss all those powerful biogra- 
phies into a desk drawer and let them molder. Or I could 
bring that information to hght to enrich the history of 
the School and e\'en the history of medicine. 

Higginbotham: Which of your discoveries most surprised you? 

Nercessian: The number of people of African descent 
who matriculated at HMS before affirmative action — 





RENAISSANCE MAN: In 1850, HMS expelled Martin 
Robison Delany, but his multiple talents as a physician, 
author, and civil rights activist led some, more than a 
century later, to regard him as the Malcolm X of his day. 



instead of the dozen or two everyone expected, I 
found at least 85. Surprising, too, was the number of 
early postgraduates training at Harvard-affiliated 
hospitals — 43. 

Higginbotham: Edwin C. ]. T. Howard has hn^ been noted as 
the first student of African descent to graduate from the School, 
in 1869. But you discovered he wasn't the onh one m that class. 



1 869 Four years after the lo7/ 



years after the 
end of the Civil War, Edwin 
C. J. T. Howard and Thomas 
Dorsey become the first con- 
firmed HMS graduates of 
African descent. Howard 
spends his career in Philodel- 
phia, where he distinguishes 
himself during the city's 
smallpox epidemic in 1 870 
by not losing a single patient 
to the disease. 



Edward Jackson Davis, 
Class of 1 899, becomes the 
first holder of the Hayden Fel- 
lowship at HMS. This first schol- 
arship fund for black students 
at HMS was named in honor of 
Lewis Hayden, who had shel- 
tered runaway slaves Ellen 
and William Craft. Hoyden's 
widow, Harriet, bequeathed 
her estate to Harvard to found 
a scholarship "for the benefit of 



poor and deserving colored stu- 
dents" with the stipulation that 
"a medical student is to be pre- 
ferred." An essayist, reflecting 
nearly two decades later, noted 
the irony. That Harvard should 
be, he wrote, "endowed by an 
old slave woman from Kentucky 
is food for reflection." Davis was 
one of at least 23 students who 
were able to study at HMS 
thanks to the Hayden largesse. 



WINTER 2005 • HARVARD MEDICAL ALUMNI BULLETIN 17 




hen Poindexter explained that he had 
slammed the door, muttering, "I'm not 




Nercessian: In fact, he wasn't c\'en the first to get up 
on stage to receive his diploma — that was Thomas 
Dorsey. The Uttle we know about Dorsey is that soon 
after graduation he moved to Washington, DC, where 
he practiced medicine for about 25 years. 

We know much more about Howard. When he prac 
ticed in Philadelphia, for example, he lost not a single 
patient during the city's smallpox epidemic in 1870. 
That same year, the governor of Pennsylvania appointed 
him the surgeon of a brigade of black militiamen. 

Howard later played a critical role in establishing the 
Frederick Douglass Memorial Hospital — at the time, 
the only hospital in Philadelphia serving African Amer- 
icans. A decade later, he helped found Mercy Hospital, 
in large part to address the lack of clinic;il training 
opportunities for the growing number of black men 
graduating from medical school. 

Higginbotham: Your book features so many remarkable 
people. Do any particular stories stand outforyou^ 

Nercessian: It's hard to choose, because I found one 
leader after another. A grandson of runaway slaves, for 
example— James Thomas Still — ^became Boston's most 
respected black physician after graduating in 1871. His 
medical practice primarily served the black population 
of Boston. He also pro\1ded leadership for the Home for 
Aged Colored Women. Many of his patients were too 



NO SURRENDER: When slave hunters demanded that 
Boston abolitionist Lewis Hayden give up William and 
Ellen Craft, the runaway slaves he was harboring in his 
home, he refused. Later, in his honor, his v^^idow created 
the first scholarship fund for black students at HMS. 




1 905 Black students at HMS 
customarily arrange for refer- 
rals from the black physicians 
of Boston and Cambridge, 
because the School requires its 
students to handle a certain 
number of obstetrical cases, yet 
many white patients at nearby 
clinics refuse to be treated by 
black students. HMS Dean 
William Richardson calls these 
"circumstances which are 



— ^S 



beyond the jurisdiction of the 
School, and which other col- 
ored students have heretofore 
cheerfully accepted." A young 
black HMS student, E. D. 
Brown '08, acknowledges thot 
HMS cannot force patients to 
accept an unwanted intern but 
petitions the dean "to put it up 
to the potients and leave me 
to face whatever difficulty 
might arise." 



I 7 I Z William Augustus 
Hinton, a pioneering syphilolo- 
gist and the first black 
American to publish a 
medical textbook, 
graduates from HMS. 
Although he has 
maintained an out- 
standing scholastic 
record, he is denied a 
position at the Harvard 
teaching hospitals. He Hinton 



begins volunteering in the 
Department of Pathology at 
Massachusetts General 
Hospital, where he per- 
forms autopsies on 
patients known to 
have had syphilis or 
suspected of having 
had the disease. He 
soon establishes himself 
s a national authority on ] 
the serology of syphilis. 



HARVARD MEDICAL ALUMNI BULLETIN • WINTER 2005 



come to assist in delivering the baby, the man 
going to let any Negro put his hand on my wife. 



poor to pay him, and when he died he had httle to leave 
his family, so he was buried in the same public cemetery 
as many of the women he had helped at the Home. 

I found the story of Hildrus Poindcxtcr '29 mo\ing 
as well. In the beginning of his career, the U.S. Public 
Health Service denied him a job because of his race; later 
he became one of its leaders. In his autobiography, 
Poindexter wrote a telling story about his early career — 
and the kind of challenges many of these early graduates 
faced. Poindexter had received a call in the middle of the 
night: an East Boston woman had gone into labor and 
needed immediate assistance. So he knocked on the 
door at three in the morning. The man ot the house, upon 
seeing a black person standing at his threshold, rudely 
asked what he wanted. When Poindexter explained 
that he had come to assist in the delivery, the man 
slammed the door, muttering, "I'm not going to let any 
Negro put his hand on my wife." 

Poindexter was walking away when a policeman 
stopped him and asked what he was doing in that 
neighborhood at that hour. After hearing his story, the 
policeman asked Poindexter to accompany him back to 
the home. "If your wife is in labor," the policeman told 
the fathertO'be, "she needs all the help she can get and 
since this Negro has the sponsorship of Harvard Med- 
ical School, he must be all right." 

Poindexter delivered the baby, and the husband 
ended up apologizing for his earlier behavior. But that 



anecdote reveals how much Poindexter had to over- 
come, making his achievements all the more remarkable. 

Stories about Frederick Douglass Stubbs '31 are 
inspiring as well. He became the first African American 
to be appointed to the housestaff of any major teaching 
hospital in the country. His first day in the hospital, when 
he sat down at a half-empty table in the cafeteria, several 
doctors left abruptly, but Stubbs met their ostracism 
with equanimity — ^just as he'd always done. By the time 
he died at the age of 41, he had enjoyed briUiant careers as 
both a surgeon and a community acti\ist. Time magazine 
praised him and medical journals praised him, but his life 
was tragically cut short by a heart attack. 

For a more recent example, almost 20 years ago John 
Anane-Sefah 70 returned to his native Ghana, where he 
started a clinic dedicated to the memory of his mother. 
He takes teams of physicians there e\'ery year. That's the 
kind of national and even international leadership I kept 
finding: great accomplishments achieved quietly, with 
enormous dignity. The stories were extremely humbhng. 

Higginbotham: How did you go about uncovering all this 
information- 

Nercessian: No single, comprehensive source existed, 
so I started with the most obvious as a launching pad, 
the School's yearbook. But that wasn't altogether rcli 
able. Then I combed the archival material in the reg- 



I V I O Louis Tompkins Wright, 
who later becomes the director 
of surgery of Harlem Hospital 
and the first black police sur- 
geon in New York City, gradu- 
ates from HMS. While a third- 
year student, he learns he can- 
not perform deliveries at the 
Boston Lying-in Hospital 
because he is "colored." 
Wright is outraged; his class- 
mates support him, and he 




Wright 



ends up participating in the 
obstetrical rotation. 

I 7 /./ After decades of 
graduating no more than one 
student of African descent per 
year (and frequently none at 
all), HMS confers degrees on 
three in one year — a record 
that is not bested until 1973, 
when affirmative action has 
mode its impact. 



1949 William Hinton '12 
becomes the first person of 
African descent to attain a full 
professorship at HMS — one 
year before his retirement. Near 
the end of his life, he creates a 
scholarship fund in honor of 
his parents, who, he wrote, 
"...although born in slavery and 
without formal education, never- 
theless practiced the principle 
of equal opportunity for all." 



WINTER 2005 • HARVARD MEDICAL ALUMNI BULLETIN 



19 




noticed a reference to the presence of a black 
matriculants. That immediately sparked my 



istrar's office. Race wasn't recorded, so I pored over 
thousands and thousands of old registration cards for 
clues about which graduates might have been of 
African descent — for example, if a person had 
received a Hayden Scholarship, which was exclusive- 
ly for students of African descent. One source that 
was extremely helpful was the African American 
Biographical Database. But it didn't list everyone. I 
stumbled upon Thomas Dorsey's name, for example, 
in The Black Aristocracy. 

One of my biggest challenges was identifying the 
very first student of African descent at HMS. The 
assumption had always been that Daniel Laing, Isaac 
Snowden, and Martin Delany were the first to matricu- 
late. But while reading one of the student petitions that 
was circulating at the time of their expulsion, I noticed 
a reference to the presence of a black student a dozen 
years earlier. That immediately .sparked my interest — 
and led to weeks of additional research. 

I finally found sources hinting that Bertrand 
Frangois Bugard, Class of 1839, may have been of 
African descent. Bugard's name suggests some French 
ancestry, but his decision to return to his native Haiti 
when he did hints at some African ancestry as well. 
After some bloody confUcts, Haiti remained inhos- 
pitable to the French throughout the nineteenth centu- 
ry, and it would have been unlikely that a man exclu- 
si\'ely of French descent would ha\-e h\'ed there at that 



time. Yet mixed-race descendants of the French rulers 
and .African sla\es — who, during French rule, enjoyed 
the privileges of land and education — constituted a 
significant proportion of the population. 

By the time Bugard returned home after graduating 
from HMS, Haiti was united under a mixed-race pres- 
ident. Bugard was likely descended from this segment 
of the population and was probably the unnamed 
"black" who had graduated from HMS before the first 
confirmed students of African descent matriculated in 
1850. But I couldn't confirm that theory, and I had to 
let it go, to my profound disappointment. It has 
haunted me — that and the fact that I couldn't uncov- 
er more information about Thomas Dorsey. 

Higginbotham: These individuals must have all had a 
remarkable drive to keep going against such tough odds. 

Nercessian: Drive they had. But I would go beyond 
dri\'e; collectively, their histories point to extraordi- 
nary levels of achievement. 

Higginbotham: Besides original sources, where else did you 

turn to find your information^ 

Nercessian: I had help from so many directions. Some- 
times I needed to ask archi^•ists sitting in other states 
for assistance in finding photographs, and even 



I V O I Mildred Jefferson 
becomes the first woman of 
African descent — and the first 
female surgeon — to graduate 
from HMS. When she was 
five, Jefferson would tog along 
with a family physician on his 
rounds, peppering him with 
questions and noting that his 
visits always seemed to moke 
his patients get better. One 
day she declared that she, too. 




Jefferson 



wanted to be a doctor, and 
he replied, "You go right on 
ahead." "I didn't know there 
were odds against what I 
was doing," she will say, 
decades later. "I just made a 
list of three medical schools 
and applied." 

1968 On April 4, Martin 
Luther King, Jr., is assassinat- 
ed. Within three days, HMS 



junior faculty members 
Jonathan Beckwith and Edward 
Kravitz organize a small group 
to respond to the "moral crisis." 
Nine faculty members sign 
a proposal to create an affir- 
mative action program. On 
April 26, following debate about 
the feasibility of a "quota," 
the proposal is approved at 
faculty meeting. Within 
one month, the faculty is 



20 



HARVARD MEDICAL ALUMNI BULLETIN • V^INTER 2005 



student a dozen years before the earliest known 
interest — and led to weeks of additional research. 




STILL WATERS RUN DEEP: One of the first HMS graduates 
of African descent, James Still was the brother of William 
Still, known as the father of the Underground Railroad. 



though they were extremely busy, they dug in. At first, 
many people in the traditionally black colleges were 
incredulous. They would say, "Oh, no — no .African 



American from here would have gone to Harvard 
Medical School." But when they found it was true, 
they'd say, "My God, he actually \\'ent there?" 

Higginbotham: You've spent a lot of time with alumni from 
before affvmatiye action, as well as with the descendants of 
many of the early graduates. What have their reactions been to 
the stories you've uncovered? 

Nercessian: Extremely positi\e. I've received a huge 
number of moving letters. And every time a graduate 
would call to thank me, I found myself getting more 
emotional. I started asking them, "Why are you thank- 
ing me- 1 didn't do the work — you did." I just refocused 
a blurr\- lens on the historical moment. 

Higginbotham: Did you encounter any reluctance on the 
part of living alumni? 

Nercessian: A few were skeptical initially because 
they'd had painful experiences at the School, but in the 
end only two declined to be included. 1 had asked all the 
h\-ing alumni to write autobiographical sketches, and at 
least 30 ended up doing so, including the postgraduates. 
The power of those narratives often left me speechless. 

Higginbotham: You have an interesting passage m the hook 
about what Toussaint Tildou '23 might have thought when he 



presented with a committee 
report that colls for the estab- 
lishment of "at least 1 5 scholar- 
ships for disadvantaged stu- 
dents." The decision is mode to 
increase class size from 1 25 to 
140, so there will be no reduc- 
tion in the number of places 
available for non-minority appli- 
cants. Ultimately, the School 
enrolls 1 6 students of African 
descent in the Class of 1973. 



1 969 The HMS Office of 
Recruitment and Retention is 
established. Although the 
School initially 
focuses on 
increasing black 
representation, it 
soon broadens 
its efforts to 
include other 
underrepresented 
groups, such as 




Poussaint 



Native Americans, Mexican 
Americans, and Puerto Ricans. 
Alvin Poussaint joins the HMS 
faculty in time to 
welcome the 
Class of 1973. 
He goes on to 
play, as faculty 
associate dean 
for student 
affairs, a pivotal 
mentoring role 



for students and colleagues, a 
role he continues to this day. 

1972 Between 1782, when 
the School was established, 
and 1972, when the last class 
of students admitted before 
affirmative action received 
their degrees, only 61 of 
1 3, 1 08 graduates were of 
African descent. Another 21 
had left without their degrees. 



WINTER 2005 • HARVARD MEDICAL ALUMNI BULLETIN 




nrichment comes only through humanization 
you fail to acknowledge someone's dignity, 



stood on the steps of Building A, taking 
stock of the ^uadnmgk. Can you tell us 
more about that passaged 

Nercessian: Tildon arrived at HMS 
from the South in 1919, at the height 
of the Jim Crow laws. The spring 
and summer before, he had wit- 
nessed incredibly bloody race riots. 
And as if that weren't enough. Har- 
vard College had become caught up 
in a series of enormous controver- 
sies, ranging from the banning of 
black students in freshmen dormi- 
tories to the membership of some 
white undergraduates in local Ku 
Klux Klan chapters. Tildon was the 
only African American at the Med- 
ical School at the time, and I won- 
dered how he felt as he stood on 
those steps, surrounded by marble 
structures, looking out over a beautifully landscaped 
lawn. What mo\'ed him? What motivated him? All I 
know is that he ended up returning to the South and 
becoming one of the most prominent physicians in 
the country after attending the School at a particu- 
larly painful moment in the history of our country 
and in the history of our institution. 




BAR NONE: Tous 
overcame racism 
a\ prominence as 



Higginbotham: How has worhingon this 
hook changed your perspective on the 
Schooh history? 

Nercessian: I understand so much 
better what growing pains the 
School has experienced and how it 
has really evolved. 

Higginbotham: You\e certainly avichcd 
the School's history by shedding light on the 
accomplishments of extraordinary individii- 
ak who had largelx been hidden. 

Nercessian: Enricfiment comes only 
through humanization and the 
recognition of the dignity of every- 
one. Once you fail to acknowledge 
someone's dignity, you've lost your 
own. For me that's very important. 
That's true for the women as well. 
There are so many achie\'ers among them and \'et, when 
women were finally allowed to enter the hallowed halls 
of the Medical School in 1945, they were warned that it 
was for a ten-year trial period. If they didn't make it, 
then the doors would once more be shut against \\-omen. 
I don't think historians should sit in judgment of the 
past. On the other hand, unearthing moments of histo- 



saint Tildon 

to achieve nation- 

a physician. 




I 7 /O The School's affirma- 
tive action program weathers o 
painful attack in the New Eng- 
land Journal of Medicine by 
on HMS faculty member who 
questions whether standards 
are being stretched to award 
diplomas to students "unable to 
handle the material." Dean 
Robert Ebert responds with a 
public defense of the compe- 
tence of the minority students 



and the integrity of HMS stan- 
dards. His statement concludes, 
"The medical school reaffirms 
its commitment to the education 
of able minority students." 

1978 HMS Dean Daniel 
Tosteson '49 convenes a com- 
mittee to ensure that the 
School's minority admissions 
policies are congruent with the 
U.S. Supreme Court's land- 



mark Bakke decision. After 
HMS officials learn of the 
School's precarious legal stand- 
ing, they create a process that 
allows the admissions commit- 
tee to pay special attention to 
race and adversity through a 
subcommittee system. Appli- 
cants then enter a merged com- 
petition in which the main 
admissions committee makes 
the final determination on all 



candidates. This process helps 
HMS admit a diverse class 
every year. 

I VOO The organization 
that will become the Hinton- 
Wright Society is founded to 
serve as a research society for 
minority HMS students and to 
introduce younger members of 
the minority community to bio- 
medical research opportunities. 



■ 



HARVARD MEDICAL ALUMNI BULLETIN • VVINTER 2005 



and the recognition of the dignity of everyone. Once 
you've lost your ov^n. For me that's very important. 



ry can only enrich the present and make it less mono 
hthic or doctrinaire. 

Higginbotham: What has the ultimate legacy of these pio- 
neers been? 

Nercessian: If I were to choose one word, it would be 
leadership. Each, in his or her way, chose the path of 
leadership, almost in every case over traditional 
options. And that was no minor feat. 

Higginbotham: And what would you say are some 0} the 
broader cautions for the future? 

Nercessian: Well, the School does a great job in terms 
of achieving diversity at the level of student admis 
sions, but diversity needs to increase at the faculty 
level — as well as at the affiliated institutions. 

Higginbotham: While medicine has diversified to some 
extent, wc have much further to go. and Harvard must continue to 
be a leader in that diversification, particularh' when we've just 
celebrated the fiftieth anniversary of Brown vs. Board of 
Education and continue to confront the c/uestion — now that 
we've mapped the human genome — about whether race has any 
biological significance. So the timing of your book is meaningful 
as we reconsider some of the basic issues that drove the United 
States into an abyss of discrimination and injustice. 



Nercessian: I wanted to ask you, Eve, as an alumna of 
African descent, what were your own responses to 
reading the book? 

Higginbotham: The word that best characterizes my 
response is pride. / jc/t proud to read about people who preced 
ed me and excelled at such high levels, not only in getting 
through Harvard Medical School, but in contributing to society 
so significantly. 

Nercessian: And if James Thomas Still were sitting here 
with us toda\', what would you ask him? 

Higginbotham: How did you do it? How did vou get through 
each day when people didn't even want to be m the same room 
with you? When everyone questioned everything you said at 
every turn? And when you didn't have anyone to share your 
experiences with? 

Nercessian: And how do vou think he would have 



k'ered? 



Higginbotham: Because he was meant to be there, that that's 
why he was placed on this earth — to get the best medical educa- 
tion possible so he could serve others, m 

Visit www.hms.harvard.edu/dcp/againstallodds to view Against 
All Odds in its entiretv online. 



IVoO The Coleus Society 
is founded to foster closer ties 
among underrepresented HMS 
graduates. The society takes 
its name from the multicolored, 
enduring coleus plant. 

1998 HMS Dean Joseph Mar- 
tin states, "Diversity in our pro- 
grams is not a question of fair- 
ness, but a question of quality — 
the quality of our educational 



programs, the quality of care in 
our medical community, and the 
quality of our research endeav- 
ors. A more diverse and cultural- 
ly representative medical commu- 
nity practices higher quality medi- 
cine and addresses research 
issues more comprehensively." 

2004 HMS convenes a 
Diversity Town Forum and din- 
ner to celebrate the publication 




Descendants of James 
Thomas Still, Class of 1871, 
celebrating Against All Odds 

of Nora Nercessian's Against 
All Odds. Attending are alumni 



of African descent, as well as 
the descendants of six of the 
earliest alumni of African 
descent. Since 1973, HMS 
has graduated more than 800 
underrepresented minority stu- 
dents. While African Americans 
now make up 1 3 percent of the 
student body, only 3 percent of 
the School's faculty members 
are people of color, an issue of 
ongoing concern for HMS. 



V^INTER 2005 • HARVARD MEDICAL ALUMNI BULLETIN 




My great- aunt the gynecologist once lifted her 
dress to reassure a skeptical patient that she, 
too, was a woman. Another aunt, in the heat of 
university politics, was murdered. A distant uncle 
assisted his queen in poisoning her husband, and a 
forefather many generations removed manipulated 
a king into relinquishing his young queen to her step- 
son. These were some of the surprises I unearthed 
when I began tracing my medical lineage. 



24 I HARVARD MEDICAL ALUMNI BULLETIN • WINTER 2005 



ft Wledical Lineage 



Sir Thomas Lewis 

b 1881 • d, 1945 







Paul Dudley White '11 

b. 1886- d. 1973 




9. 



^tP 

^ 



Several years ago I struck upon the 
notion of constructing an academic 
genealogy for my residents, a sort of 
medical family tree, to present to them 
at graduation. I thought I might have 
inherited a few habits from some line of 
teachers — an insistence upon going to 
the bedside, for example, or a certain 
manner of holding the patient's hand 
while feeling the pulse with the fingers 
of the opposite hand — habits I might 
have also passed on to my students. I 
aimed to trace this heritage through 
time from my mentor back perhaps even 
to Hippocrates. This project might take, 
I naively calculated, a long weekend at 
Harvard's Countway Library of Medi- 
cine, v\'ith perhaps a few weekday after- 
noons thrown in, and I would be fin 
ished. That was three years ago, and I 
am still far from done. 

At the beginning of my undertaking, 
I must confess, I yearned to be related 
to the great WUliam Osier. But I never 
could establish that link and had to 
content myself with such "relatives" as I 
could honestly own up to. After all, I 
had to follow some rules — even if they 
were rules of my own making — for 
the genealogy to be legitimate, both for 



David Edsall 

b. 1869- d. 1945 

9 



Edward Franklin Bland 

b. 1901 • d. 1992 




Joseph Aub '16 

b. 1890 ■ d. 1973 






Fuller Albright '24 

b. 1900- d, 1969 



^ 




William Morgan, Jr. '52 

b. 1927 





Michael LaCombe '68 

b. 1942 



V 



me and my students. That Osier had 
worked in the same hospital with three 
of my "ancestors" — Sir Thomas Lewis, 
James Mackenzie, and Sir Clifford 
Albutt — did not make him a relati\'e of 
mine by any stretching of those rules. 

No, the connections between mem- 
bers of my family tree would have to be 
strong, the contact personal, the impact 
profound. John Caius (1510-1573), for 
example, roomed with Andreas \ esalius 



Alice Hamilton 

b. 1869 • d. 1970 



9 



(1514-1564) for a year at the Universit)' 
of Padua. Ample personal contact there, 
certainly. And Hippocrates's biologic 
daughter, whom only Islamic scholars 
have named, became so great a physi- 
cian she was called "Aesculapius-like 
Doctor." Such pedagogical links would 
descend directly to me. 

Soon, however, I found that history 
would force me to make exceptions and 
leaps through time, because no links of 
personal contact can be established for 
entire centuries, when nameless physi- 
cians simply cared for their patients 
while teaching their students the trade. 
And great translators who never met 
their mentors sustained medicine in the 
Middle Ages. Special cases exist, too, 
such as that of Giovanni Borelli 
(1608-1679), who never met Wilham 
Harvey but was, through the writings 
of the latter, more profoundly influ- 
enced by him than by any of his person- 
al instructors. 

Before long, an odd thing happened 
to me: the library cubicle in which I sat 
surrounded by growing towers of dusty 
history books assumed the proportions 
of a monastery cell. I retreated in time, 
imagining myself at Jarrow and Monte- 



HARVARD MEDICAL ALUMNI BULLETIN • WINTER 2005 



cassino, listening to the N'enerable Bedc 
and Constantine the African anxious to 
tell me stories about the family. 

Meet the Grandparents 

1 began the project by calling my men 
tor, William Morgan, Jr. '52, now a 
retired cardiologist, to ask who had 
influenced him as profoundly as he had 
helped mold me. 

"Two people," he answered without 
hesitation. "Fuller Albright and Ed 
Bland." 

N lorgan had trained under both men at 
Massachusetts General Ho.spital. At that 
time, Albright '24 suffered from post 
encephalitic Parkinson's disease. .An a\'id 
flyfisherman, he contended that his 
tremor gave wet flies on his line just the 
right shimmy to dupe fish. Considered 
one of the founders of endocrinology, 
.Albright taught one of the most co\eted 
electives for Har\'ard medical students. 

"It was a great honor for a senior 
student to take the month-long elec 
tive with Fuller," Morgan told me one 
time. "The .student would climb into 
Fuller's old car, dri\e him to the ho-spi- 
tal, sit at his elbow, and then drive 
him home. Kurt Isselbachcr ['50] was 




FRIEZE FAME: This classical Greek stele depicts Aesculapius — the celebrated god 
of healing — treating a patient. 



determined to take the elective but 
didn't know how to dri\-e, so he hastily 
took lessons. One day I asked Fuller 
what it had been like with Kurt behind 
the wheel, and he replied, 'It was the 
only time I stopped shaking.'" 

Albright's two greatest influences 
were Jacob Erdheim in X'ienna and 
Joseph Aub '16. Aub, who did cancer 
research at Massachusetts General 
Hospital, was a friend of Paul Dudley 
White '11 and George Minot '12 and 
studied under William Councilman; 
Richard Cabot, Class of 1892; Frederick 
Cheever Shattuck, Class of 1873; Henry 



Christian; and Walter Cannon, Class of 
1900. But had you asked Aub to phone his 
mentor, he'd have rung up David Edsall, 
who later became dean of Har\'ard Med- 
ical School. Edsall's mentor in turn was 
the legendary diagnostician William 
Pepper, Jr., at the University of Pennsyl- 
vania, who was most greatly influenced 
by Alfred Stille, professor of the theory 
and practice of medicine there. 

In Stifle's time, during the first half 
of the nineteenth century, U.S. medical 
schools had no microscopes, Massachu- 
setts law forbade dissections, and anato- 
my could be taught only after graves had 




flUce H(iwii^ton^ iSdg-igyo 



One collateral ancestor I am proud to claim is my "great-aunt" Alice Hamilton, considered 
the founder of occupational medicine. After graduating from medical school at the University 
of Michigan in 1 893, she pursued further training in Germany. At the universities in Munich 
and Leipzig she was allov/ed to audit lectures provided that she sit in the back of the lecture hall 
to avoid distracting the male students and professors. During the typhoid fever epidemic in Chicago in 
1902, Hamilton made the link between sewage, flies, and the transmission of the disease, leading to the reorganization of the Chicago 
health department, the establishment of the Occupational Disease Commission, and her appointment as its first director. 

My "great-grandfather" David Edsall recognized Hamilton's excellence and recruited her to Harvard to teach industrial medicine in 
1919. But the university fathers balked at her appointment. She would have been the first female professor at a medical school that wouldn't 
admit women as students until 1945. A compromise was struck. She could hold the rank of assistant professor, but she hod to forgo the 
usual perks of a faculty appointment: use of the Faculty Club, a place in the commencement march, and tickets to Harvard football games. 

Hamilton would go on to receive many honorary degrees. She was the first woman to win the Albert Losker Public Service Award 
and, in 1944, to be listed in Men of Science. But she never received a promotion at Harvard, retiring in 1935 as assistant professor 
of industrial medicine emeritus. ■ 



WINTER 2005 • HARVARD MEDICAL ALUMNI BULLETIN . 27 



^ 




generations before and five 



^f»^ 



^^ 



been robbed. To further their education, 
a group of Boston and Philadelphia med 
ical students traveled to Paris to study 
obstetrics under Mme. Marie-Louise 
Lachapelle, and anatomy and surgery 
with Baron Guillaume Dupuytren and 
Pierre Charles Alexander Louis. When 
several of these American students — 
Stifle, William Pepper, Sr., and Oliver 
Wendell Holmes, Class of 1836, among 
them — celebrated Independence Day in 
1833 with dinner at Frascati's in Paris, 
they had the panache to invite the 
Marquis de Lafayette to join them. 

Morgan's second mentor, Edward 
Bland (my other "grandfather"), intro- 
duced cardiac catheterization at Massa- 
chusetts General Hospital. Morgan 
describes him as a modest, gifted bed 
side teacher, preeminent in auscultation 
and chiefly interested in acute rheumat- 
ic fever and rheumatic heart disease. 
Paul Dudley White, who had recruited 
Bland to the hospital, also greatly influ- 
enced him. At a time in my life when I 
held little respect for history, I had the 
good fortune to enjoy five minutes of 
bedside teaching from White, the father 
of American cardiology and one of my 
"great- grandfathers." 

As a third-year medical student, I had 
been sent to the hospital's overnight 
ward to examine a patient. I was intent 
upon listening to the heart sounds — 
from the \\'rong side of the bed as I 
remember — when a diminutive white 
haired man asked what I was doing. He 
looked frail, even ancient. 

"Trying to figure out this murmur," 
I said. 

"Listen over the acromion, on the 
left," he said. "Can you hear it there?" 

I thought maybe I could. "Yes," I said. 

"Then it's aortic stenosis," said the 
old man. 



"Why?" 1 asked. 
"Because Lve never heard any other 
murmur radiate to the left acromion." 

"Do you ha\'e a reference for that?" I 
asked. 

"No. That's just been my experience." 

"Still riding your bike, Doc?" asked 
the patient. 

"You bet," said the old man, before 
turning and walking away. 

"Do you know who that was?" the 
patient asked me. 

"No," I said. 

"That was Paul Dudley White, kid," 
said the patient. "Don't forget this." 

Maternal Intuitions 



After perhaps a year's research, I had 
completed ancestral links to Hippocrates 
for seventeen generations before and fi\'e 
generations after his time. I had also con- 
nected myself through Morgan, Albright, 
Aub, and Edsall back to the thirteenth 
century with only moderate difficulty. 

But my most recent research has been 
consumed mostly with the Middle Ages 
and with connections between the 
Roman, Nestorian, Arabic, and Benedic 
tine translators. I discovered three 
great-aunts, including Agnodice (fourth 
century B.C.), the gynecologist who lift- 
ed her tunic. Agnodice, who may have 
been a figure of legend, is held to have 
lived in Greece at a time when women 
were forbidden to study medicine. But 
she wanted to be a doctor and with the 
support of her father traveled to Egypt 
to train. The only account of her that 
has survived is given by Hyginus, a his- 
torian of the first century A.D. 

Agnodice, the story goes, had dis- 
guised herself in men's clothing to learn 
medicine under Herophilus. One day, 
she heard a woman in the throes of labor 
and rushed to her side, only to ha\'e her 
help refused. Agnodice lifted her hem to 
reveal her gender, and the woman grate 
fully accepted her ser\ices. When local 
doctors learned of this new, popular 



ri\al, they began to accuse Agnodice of 
seducing patients. 

When Agnodice was brought to trial, 
she once again lifted her tunic to prove 
she was a woman. The local doctors 
became all the more enraged and 
charged her with breaking the law that 
forbade women to study medicine. "At 
this point," Hyginus wrote, "the wives of 
the leading men arrived sarong, 'You men 
are not spouses but enemies since you 
are condemning her who discovered 
health for us.' Then the Athenians 
emended the law so that freeborn 
women could study medicine." 

Another historian has suggested that 
these "wives of the leading men" were in 
fact wives of the court judges and had 
threatened suicide unless their hus- 
bands set Agnodice free. The judges did 
so and permitted her to practice medi- 
cine as long as she treated only women. 

Another great- aunt I uncovered was 
Hypatia of Alexandria, the foremost 
mathematician of her time, and a legend 
in a school that had survived since 
Herophilus and Erasistratus had found- 
ed it 800 years earlier. As head of the 
Platonist school at Alexandria about 
400 A.D., Hypatia lectured on philoso- 
phy as well as mathematics and grew 
famous for both her remarkable beauty 
and charismatic teaching. But Hypatia 
involved herself too deeply in politics — 
something academics should never 
do — siding with Orestes against Cyril, 
patriarch of Alexandria. For this she 
was reputedly murdered by a mob of 
Nitrian monks. Soon after her death, 
scholars began abandoning Alexandria, 
marking the beginning of its decline. 

I traced a circuitous path to a third 
distant aunt as well. Mondino de' Luzzi 
(1275-1326) studied under the great Tad- 
deo Alderotti, founder of the medical 
school at the University of Bologna. 
Mondino is said to have had a valuable 
laboratory assistant, a young woman 
named Alessandra Giliani, who had a 
gift for dissection and became the first 



HARVARD MEDICAL ALUMNI BULLETIN • WINTER 2005 



links to rtippocrates for si 
generations after his time. 



to inject blood vessels with colored liq- 
uids, the better to study their courses 
and relations. Mondino would be 
remembered for centuries as "the restor 
er of anatomy"; GQiani has been largely 
forgotten. In The Evolution of Modem Mcdi 
cine. Osier wrote, "She died, consumed by 
her labors, at the early age of nineteen, 
and her monument is still to be seen." 

Avuncular Matters 



While the histories of my female ances- 
tors made up in color what they lacked in 
quantity I unearthed no short- 
age of equally eccentric uncles 
from the family archives. 
Darius (ca. 558-486 B.C.), king 
of Persia, sustained a fracture 
dislocation of the ankle while 
horseback riding. None of his 
seven physicians could reduce 
it. It was rumored that among 
the Greek slax-es was a certain 
Democedes, reputed to be 
a doctor. When the king 
ordered him brought forward, 
at first he denied his profes 
sion, reasoning that if his 
excellence became known, he 
might remain forever enslaved 
Only when faced with torture 
did Democedes relent, treat 
the king, and reduce the frac 
ture. In a few weeks the king 
was riding again. He sum 
moned Democedes before him 
once more, and rewarded hi^ 
doctor with chains and shack 
les of pure gold. (Democedes 
later gained his freedom when 
Queen Atossa secretly arranged 
his escape after he cured her 
of a breast abscess.) 

Erasistratus (ca. 310-250 
B.C.), called the founder of 
physiology and the father of experimen- 
tal medicine, was a contemporary of 
Herophilus and a legend in the early 
days of the School of Alexandria. One 



day, the story goes, Seleucus, the king 
of Syria, summoned Erasistratus to his 
son's bedside. Antiochus was dying, and 
none of the court doctors could diag- 
nose his ailment. After a careful history 
and physical examination, Erasistratus 
reasoned that Antiochus was dying 
of unrequited love through, as Plutarch 
later recorded, "neglecting his person 
and refusing nourishment under the 
pretense of being ill." The challenge for 
Erasistratus was to find the object 
of Antiochus's devotion. He therefore 
paraded the women of the court before 






moment of diagnosis; Erasistratus, 



his 





MONKISH BUSINESS: During the Middle Ages, medical 
knov/ledge was translated and preserved In monasteries. 
In this medieval painting, a doctor cauterizes a patient. 



his patient, all the while carefully 
observing Antiochus's vital signs. 

The painter Jacques- Louis David 
famously captured on canvas the 



hands on the pulse and precordium of 
his patient; the desperate father, Seleu- 
cus, holding his son; and the beautiful, 
unattainable Stratonice standing at the 
foot of the bed. Only at this moment did 
Erasistratus observe in his patient, "ail 
Sappho's famous symptoms — his voice 
faltered, his face flushed up, his eyes 
glanced stealthily, a sudden sweat broke 
out on his sldn, the beatings of his heart 
were irregular and violent, and, unable 
to support the excess of his passion, he 
would sink into a state of faintness, pros- 
tration, and pallor." 
:■ The situation was more 
complicated than might seem 
at first blush; Stratonice was 
the young second wife of 
Seleucus and so stepmother to 
Antiochus. Therein lay the 
therapeutic dilemma. Erasistra- 
tus decided to employ reverse 
psychology. He told the king 
his belo\'ed son's malady was an 
impossible love — because the 
object of his heart was Erasis- 
tratus's own wife, with whom 
he was not willing to part. 
When the king pleaded, the 
physician declared that Seleu- 
cus would surely not give up his 
own wife. His tactic worked. 

"Ah, my friend," answered 
Seleucus, "would to heaven 
any means, human or divine, 
could but convert his present 
passion to that; it would be 
well for me to part not only 
with Stratonice, but with my 
empire, to save Antiochus." 
Seleucus then summoned a 
general assembly, declared 
that he had resolved to make 
Antiochus king and Stratonice 
queen of all the provinces of 
Upper Asia, uniting them in marriage. 
And everyone li\'ed happily ever after. 

Well, not everyone. Tiberius Claudius 
Nero Germanicus (10 B.C. -54 A.D.), of 



WINTER 2005 • HARVARD MEDICAL ALUMNI BULLETIN 



29 



/, Claiuhus fame, was the third emperor of 
the Julio Clauclian dynasty o( Rome, a 
dynasty that would end with his adopt 
cd son, Nero. Because Claudius limped, 
drooled, stuttered, and was constantly 
ill, he was never considered a threat to 
accession to the throne, and so when the 
poisons were passed around, Claudius 
escaped assassination. That is, until he 
became emperor. When his wife, Mes 
salina — described by historians as a 
pouting adolescent nymphomaniac — 
was executed for infidelity, Claudius 
was persuaded to marry Agrippina the 
Younger, who had great ambitions for 
her son, Nero. The story of Claudius's 
assassination by Agrippina is confused, 
but one version has it that he did not die 
quickly from the poisoned mushrooms, 
and so had to be targeted again, this time 



by the court physician Xenon, who 
dipped a feather in poison and applied it 
to the back of Claudius's throat under 
the pretense of inducing vomiting. 

Another eccentric old uncle, Jibril ibn 
Rakhtishu (died ca. 828), the famous 
Nestorian physician and unparalleled 
diagnostician, was called to Baghdad to 
treat the caliph, Harun alRashid. This 
was at a time in medical history when 
consideration of the pulse and urine was 
paramount in making a diagnosis. The 
caliph wanted to test Bakhtishu's ability 
before enlisting his services. Harun 
obtained the urine of a mule and present- 
ed it to Bakhtishu for analysis. Another 
physician, Abu Quraysh, swore it was the 
urine of a favorite slave girl. Bakhtishu 
carefully examined the specimen, and the 
caliph asked what treatment he would 



advise. Bakhtishu replied that a good 
feed of hay and barley would be the best 
medicine. He got the job. 

All in the Family 

I finished my project in time for gradua- 
tion and presented to each of my 
students an individualized medical 
genealogy — an illustrated chart com- 
plete with famous people, buildings, 
and quotations. The final family tree 
measured seven feet by two. One resi- 
dent, in a wonderfully ingenuous dis- 
play of reductionism, asked me to single 
out the greatest of her ancestors. 

"Who's most important?" she asked. 
"I mean, whom do you think?" 

I suddenly thought back to Muham- 
mad ibn Zakariya al-Razi (865-925), 




TBranching Out 



To chart a medical 
history of your own, 
start with a phone coll to 
your mentor or to the person who most influenced your medical 
career. It should be a simple matter to establish links from that 
individual to his or her "parents" as well as to your "great-grand- 
parents." But then, increasingly, you will have to make choices. 
You will need to be diligent about your research and honest in 
recording the results. Genealogical software, such as Reunion for 
the Macintosh or Family Tree Maker for the PC, helps immensely 
in tracking all the information you uncover. 

You ore "doing history" as historians would soy, and you are 
about OS qualified to do so as any historian is qualified to run a 
vent. Check your facts. Verify your dates. Get proof. Only when 
you are certain should you record a link. If ambiguity arises, 
document that ambiguity. Someone somewhere will examine 
your genealogy and take it as gospel, just as undoubtedly 
someone reading my article has jumped to the conclusion that 
I am a direct biologic descendent of Muhammod al-Razi. 



COUNT HER IN: The author's "great-aunt" Hypatia was 
the leading mathematician of her time. 



Books were my greatest resource. Arthur Selv^ryn-Brown's The 
Physician Throughout the Ages (two volumes, Capehart-Brown 
Co., Inc., New York, 1928) helped dispel my ignorance of 
medical history, although, as a compendium of essays and 
biographies mostly by physicians (rather than historians), it 
contains many inaccuracies. Though largely forgotten, Cecilia 
Mettler's History of Medicine (The Blakiston Company, Philadel- 
phia, 1947) is better than Fielding Garrison's. At last count I 
hod used 1 16 sources, but none can compare to George 
Sarton's histories of science. 

Initially, my aim was to go as far bock as Hippocrates — if not 
beyond — through personal links between teacher and student. 
How ignorant I was of history! In the Middle Ages medical 
knowledge was transmitted solely through literature, by the great 
translators of medical texts. In the late Greek and early Roman 
periods we know only of schools of medical pedagogy, the indi- 
vidual teachers having been forgotten for centuries. And in one 
cose, although I found strong links of personal contact, I chose 
instead a connection involving contact only through medical liter- 
ature: Giovanni Borelli (1608-1679) received personal instruc- 
tion from Rene Descartes and Galileo, yet William Harvey's 
De Motu Cordis largely influenced his medical thought. 



30 



HARVARD MEDICAL ALUMNI BULLETIN • V\^INTER 2005 



who had more than 200 outstanding sci^ 
entific contributions to his credit, about 
half dealing with medicine. He estab 
hshed and was the first chief of a Baghdad 
hospital. He picked the site for the hospi- 
tal by hanging pieces of meat in various 
quarters of the city and later examining 
them for putrefaction. He then cho.se the 
site where the meat had decayed the least. 
All this he did a thousand years before 



Pasteur and Koch. But those accomphsh 
ments weren't why I chose him. 

"Well," I told my student, "I'll never 
forget your great-grandfather, Muham- 
mad al-Razi, and the words he lived by; 
'No blame is there upon the blind nor 
any blame upon the lame nor any blame 
upon the sick and as for the insane: 
...feed and clothe them.. .and speak 
kindly to them.'" 



Somewhere in the process of my 
research, I realized, the names had 
turned into people, and then the links 
to me had become ancestral in the 
strongest sense of the word — and I had 
grown compelled to learn more about 
those physicians. The ego-driven exer- 
cise to connect myself to Osier-like icons 
no longer mattered. Whatever the era, I 
discovered doctors who had struggled in 
ways that I struggle; who had contended 
with adversity, politics, and hardship in 
ways that made my efforts pale in com- 
parison; and who nevertheless pro- 
duced, excelled, and mattered. ■ 

Michael LaCombe '68 is a cardiologist at Maine 
General Medical Center and associate editor of 
the Annals of Internal Medicine. "Relatives" 
may reach him at mlacomhe@mainegcneral.org. 




I recorded all the information in my genealogical software, printed 
out cfiarts, and presented tfiose cfiarts to my students at graduation, 
along with a PowerPoint presentation illustrating the links. The effect 
was greater than I had anticipated. They were overcome. A few wept. 
I had to keep my head down to hold it together and completely 
missed the standing ovation my v^ife desperately wished I would see. 



Many Harvard Medical School alumni 
have a strong connection with one of the 
Brigham hospitals, linked perhaps to cardiolo- 
gist Samuel Levine, either directly or through 
cardiologist Bernard Lown. Levine called 
Henry Christian, the HMS Hersey Professor of 
the Theory and Practice of Physic, "Uncle 
Henry." Christian studied under William Osier 
V '"^^^^^l cit Johns Hopkins, who in turn listed among 

'^^^^^^ those who greatly influenced him the great 
German pathologist Rudolf Virchow. Those 
v/ith Beth Israel Hospital connections may link 
themselves to Hermann Blumgart, the father of 
diagnostic nuclear medicine, who worked 
closely with the legendary physiologist Soma 
Weiss, who studied physiology in Budapest. 
Others undoubtedly share my own connections through Massachu- 
setts General Hospital, perhaps even as recent in the family tree as 
with Edward Bland or Fuller Albright. 

Alumni should feel free to contact me for more suggestions about 
embarking on their medical genealogies, so they can begin to hear 
their own eccentric aunts and uncles spin the family tales. ■ 



WINTER 2005 • HARVARD MEDICAL ALUMNI BULLETIN 



31 



A pediatrician immerses himself in the 

study of acupuncture — and connects himself and 

some of his patients to an ancient legacy. 



By Earnest Wu 



A FEW DAYS BEFORE' THANKSGIVING, MORE THAN 15 YEARS AGO, 

my wife, Lee, sprained her ankle so badly it ballooned to twice 
its normal size. The maroon and violaceous swelling invited 
clucks of sympathy from my medical colleagues, who suggest- 
ed icing, then heat, elevation, and an occasional anti-uiflam- 
matory. The prognosis for attending a formal Thanksgiving 
dinner, they all concluded, was grim, adding that Lee should 
expect a lengthy rehabihtation. But an acupuncturist had 
recently opened an office nearby, and 1 encouraged my wife to 
see her. ■ Barbara's office was austere. Nestled on rows of 
shelving were glass jugs containing dried herbs, twigs, 
branches, mushroomTike caps, and mysterious powders, all 
browTi, white, or gray. On the opposite side of the room, stand- 
ing pots of bamboo framed life-sized acupuncture charts 





The sphere contained a long hst of ingredients, 
of which I recognized only one — ^bear gallbladder. 



mapped on human silhouettes. The air held that distinctive 
smoky, herbal tang of incense I associated v\ith the New York 
Chinatown apothecaries of my youth. 

Barbara was in her early forties, with grann)' glasses and a 
sharp intellect. To take up acupuncture, she had abandoned 
a successful career as an aeronautical engineer. "I used to 
make weaponry for the U.S. military," she cheerfully 
explained, "but then I decided to become a healer." 

After taking a history from Lee, Barbara examined her 
much like a Western-trained doctor might have, pa)ing spe- 
cial attention to her pulse and lapng her hands on Lee's belly. 
After pronouncing a Chinese diagnosis, Barbara inserted 
needles at various points on Lee's body. She connected the 
needles she had placed around the ankle to an electrical 
device that provided additional stimulation. 

Before we left, Barbara gave Lee a golfball-sired, dark 
browTi, gummy sphere with instructions to nibble it, a bit at 
a time, to help reduce inflammation. The mystery substance 
contained a long Hst of unpronounceable, cryptic ingredi- 
ents, of which I recognized only one — bear gallbladder. 
Tangy, sweet, sour, salty, chewy, and slightly rancid- 
smelling, a chocolate truffle the remedy was not, despite its 
outward appearance. Lee dutifully choked it dowTi and 
returned for two additional acupuncture treatments. 

Within 24 hours, although Lee's anlde \\'as still \isibly 
bruised, the sweUing began to recede dramatically; by day 
three, it looked \irtually normal. We stepped out in fashion 
that Thanksgiving, Lee in a designer gown and heels. 
Doctors who had examined her traumatized ankle were 
amazed — and I was one of them. 

Unclaimed Inheritance 



For the nearly 20 years I ha\'e been practicing pediatrics, I 
ha\'e largely stayed within the parameters of a Western med- 
ical approach. Following my wife's experience, though, and 
my own subsequent efforts to educate myself about 
acupuncture, I have not hesitated to recommend it whene\'- 
er I thought it appropriate. I am always willing to discuss 
complementary approaches to such problems as chronic 
pain, stress, musculoskeletal wear and tear, fibromyalgia, 
chronic fatigue, high blood pressure, and the side effects of 
chemotherapy. In recent years, patient interest in such reme- 
dies has increased sharply and I now typically have such 
discussions several times a week in my practice. 

But if anyone had predicted to me w'hen I entered medical 
school in 1972 that I would, mid-career, find myself regular- 
ly encouraging patients to explore complementary medical 
approaches, I would have scoffed. My Xhindarin family had 
eagerly embraced Western science and medicine — two 




T 



A 





uncles and their wi\'es became doctors and my mother a 
nurse. They seemed to disdain traditional Chinese medicine 
as backward, even slightly embarrassing. 

But mixed in with the Western medical texts in the library 
of my childhood home was the odd scholarly tome or r\\o 
about acupuncture and Chinese medicine — reUcs, I suspect, 
from the medical training days of some of my rekti\es who 
would likely ha\'e been exposed to acupuncture as part of a 
Chinese medical curriculum. I occasionally thumbed through 
those books, wanting to touch something that resonated with 
my cultural heritage. But each time I found my initial excite- 
ment turning to bewilderment and ridicule: "Liver on Fire? 
Damp Heat in the Spleen? What is this? It makes no sense!" 

Ironically, it wasn't until I was in the thick of my training 
at HMS that I made my first tentative rediscovery of this 
legacy. One day, during my cardiovascular training, I heard 
Herbert Benson '61 describe what he called the relaxation 
response. Now this is interesting, I thought. Here was the 
documented fall of blood pressure induced, without medica 



34 



HARVARD MEDICAL ALUMNI BULLETIN • WINTER 2005 



I wiununuimiinnnnnnnninnniiiy.nnnimi.L.. 




tion, merely by regulating the breath — the first acknowl 
edgement of the mincl body connection I had heard durin 
my entire HMS education. 

On Pins and Needles 



As fascinating as I found Benson's research, I didn't pursue 
any efforts to educate myself in the growing field of comple 
mentary and alternative medicine until much later. A few 
years ago, I was about to toss an ad\'ertisement for a medical 
conference in the trash \\'hen my eye caught the picture of 
an internationally known practitioner of Japanese acupunc- 
ture, who also happened to be my acupuncturist. 

When seeking rehef for a nast\' bout of tendonitis that 
cramped my right thumb so badly I couldn't e\'en grasp a 
pen, I had turned to acupuncture rather than orthopedics. 
Barbara had mo\'ed out of town by then but I tracked down 
one of her teachers, about whom she had always spoken 
highly. In one treatment, Kiiko Matsumoto had been able 
to relie\'e nearly all my pain. At her recommendation, I 
returned lor a couple of touchups. .And now, the ad\'ertise- 
ment proclaimed, she would soon be co-directing and 
teaching a course entitled "Medical Acupuncture for Physi- 
cians" — at Harvard Medical School. 

Acupuncture at HMS? The possibility struck me, as 
someone who had graduated from the School in the mid-sev- 
enties, as unlikely. But the course delivered what it had 
promised. 0\er nine months, an impressive faculty of physi- 
cians and acupuncturists covered the neuroanatomy and 
neurophysiology related to a scientific understanding of 
acupuncture, including functional MRI studies of its effects. 

A great deal of acupuncture theory — the equi\'alent, I was 
told, of the three-year curriculum at the New England School 
of Acupuncture — was dissenunated in a way that demon- 
strated how much Eastern and Western medicine overlap 
conceptually. After a while, I was no longer surprised about 
how much these two traditions had in common. Although 
their vocabularies differ radically, they both obser\'e and 
respond to the same realities of the human condition. 

In unchanged fashion, alcoholism, cancer, hepatitis, and 
other afflictions have ravaged the royal courtier in old Bei- 
jing, the English settler at Jamestown, and the Prague res- 
ident of today. The ancient Chinese healers were, in their 
own ways and words, extraordinarily astute observers of 
such phenomena. They had a keen awareness, for example, 
of Down syndrome and understood that it came from a 
baby's parents, even though they wouldn't have explained 



it in terms of faulty gene replication. 
Instead, they spoke about "ancestral 
chf — a different take on genetic 
inheritance but conceptually similar. 

Our first Saturday clinic engendered all the excitement 
and anxiety that a medical student might feel during a first 
class in physical diagnosis. Textbooks in hand, we took 
turns painstakingly tracking all the major acupuncture 
points on each other. Later we practiced needling and 
burning "moxa" — an acronym derived from moxibustion, 
or the burning of the dried fungus Artcmma vulgaris. Nearly 
painless when administered correctly, moxibustion stimu- 
lates acupuncture points through the application of tiny, 
yet intense flares of heat. 

Just as I had struggled to learn "medicalese" in m)- first year 
of medical school, I stumbled over the vocabulary and con 
cepts of Chinese medicine. I still ha\'e trouble comprehending 
a "damp spleen," for example, but I ha\'e begun to understand 
"empty heat in the lower burner." It is, if you think about it, a 
wonderfully poetic yet logical way to conceptualize subtle 
biological processes. The ancient Chinese intuited somehow 
that they had to lower the fire if it burned too intensely, or 
they had to provide fuel in cases where the supply ran low. 
In either case, the idea was to remediate a level of disharmo- 
ny in the chi, or life energy, that flows through each of us. 

As part of the natural aging process, someone entering 
menopause or andropause would present with "empty heat in 
the lower burner." But a prematurely menopausal patient — 
say a 29 year-old woman whose o\'aries had been remox'ed or 
whose chemotherapy had induced symptoms of end-stage 
menopause — would also lead a Chinese physician to declare 
the patient as suffering from the same phenomenon. 

Schooled in the analytic, reductionist paradigm of the 
Western scientific method, I found it difficult to think in the 
inductive, intuitive paradigm of Eastern medicine, in which 
patterns of symptoms and observed disharmonies form the 
bases for diagnosis and treatment. The reasoning is often cir 
cular; the diagno.sis may also be the template for treatment. 
At e\'ery lecture, I would ha\'e to leave my Western mentali- 
ty outside the door and try to free up my imagination. 

Of Longitudes and Latitude 

Acupuncture follows the behef that the energies that circu 
late within our bodies should be in harmony with the ener- 
gies of nature. According to Chinese medicine, twelve 
meridians and two major channels serve as superhighways 
for energy flow in specific directions. Kidney, liver, heart, 
pericardium, spleen, and lung compose the six Yin meridi- 
ans; bladder, gallbladder, small intestine, triple warmer. 



WINTER 2005 • HARVARD MEDICAL ALUMNI BULLETIN 



35 



My initial excitement turned to bewilderment: 
"Liver on Fire? Damp Heat in the Spleen?" 



stomach, and large intestine represent the six Yang meridi 
ans. The Conception Vessel and the Governing Vessel are 
the two major channels running up the anterior midline and 
posterior midline respectively. These are interconnected 
with "extraordinary channels" and further interlaced with 
small, smaller, and then fine channels, such as the luo merid 
ians. The idea is roughly analogous to the numerous major 
and minor vessels and capillaries of our circulatory system. 

But I had to keep reminding myself that the meridian 
name did not designate the actual static, somatic structure 
of an organ. It refers instead to the physiologic equivalent in 
Chinese medicine and then some. Meridians have diverse, 
empirically determined functions that greatly transcend the 
Western notion of a collection of highly differentiated and 
organized cells performing a particular activity. 

For instance, the Western spleen is a specific structure 
of the lymphoreticular system. Its intricate and integrated 
organization allows it to clear foreign antigens, remove old 
or damaged red blood cells, regulate portal blood flow, or, 
even, under some circumstances, make blood. The Chinese 
spleen, as a meridian, governs the transformation and 
transportation of nutrients (the ancient Chinese under- 
stood that the fluctuation of blood sugar was inherent in 
this, and acupuncturists exploit points to help manage 
diabetes); regulates the Blood; controls the muscles and the 
four limbs; and houses Thought. 

If a patient presents, in the aftermath of the death of a 
loved one, a history of frequent colds and cough, anorexia, 
pallor, weight loss, and fatigue, a Western-trained physician 
may check the complete blood count and chemistries, order 
an x-ray, prescribe an antibiotic or an antidepressant, rec- 
ommend rest, and suggest seeing a mental health provider. 

A Chinese doctor — knowing that the lung meridian 
houses the Corporeal Soul and that grief powerfully and 
negatively affects breathing (from sobbing to shallov^', 
short breaths in a chest that feels constricted), which, in 
turn, depresses many other body functions — will treat 
points, among others, on the lung meridian, and prescribe 
herbs to rebalance energy, enhance immunity, and address 
grief. As Western medicine has evolved its own patchwork 
of chemistry, physiology, anatomy, and now genetics. East 
ern practitioners have conceived, over several thousand 
years, their own empirically based medical construct and 
forged it into a rational system of diagnosis and treatment 
with its own internal logic. 

My acupuncture classmates and I sometimes found this 
logic unnervingly elusive, but when we fully embraced the 
Eastern paradigm of thought, the logic unfolded beautiful 
ly. The notion that tiny needle stimulations of a point on, 
say, the inside edge of the great toenail can relieve a paintui 




reflex at the intervertebral space between the third and 
fourth cervical vertebrae sounds outlandish. Yet, many 
advancements in Western medicine took zigzagging paths 
that grew out of be\\'ildering observations or seeminglv 
preposterous thoughts: Edward Jenner used cowpox as an 
immunization against smallpox; the chewing or brewing of 
a tree bark managed or cured malaria; citrus fruits warded 
off scurvy. The science of understanding came much later. 
One current theory of chronic pain, for example, is that 
highly sensitized afferent nerve receptors are primed by 
chronic inflammation due to organ, joint, or musculoskeletal 
pathology, as well as alterations in levels of stress and mood. 
It may well be that, through the interconnection of nerve 
pathways, a palpated area of pain can be released by a dis- 
tal point because minimal acupuncture needle stimulation 
produces, as perceived by the nervous system, a barrage of 
afferent signals that cs.sentially counter the pain .signals. 



36 



HARVARD MEDICAL ALUMNI BULLETIN • WINTER 2005 




West Meets East 

Although 1 ha\'e continued my acupuncture studies as an 
apprentice and ha\'e practiced on friends and fainily mem- 
bers, I ha\'e not incorporated acupuncture into my clinical 
practice because of hesitations on the part of my senior col- 
leagues. Yet at the same time I continue to evaluate clinical 
problems in a Western manner, I often rely on the diagnostic 
aspects of my acupuncture training to complement my prac- 
tice. As data accumulate, I formulate my chmcal manage- 
ment plans and refer patients to acupuncturists when it 
seems most appropriate. 

Witnessing the positive, practical effects of complemen- 
tary approaches in patients has been deeply affirming. I 
recently saw, for example, a 12-year-old girl suffering from 
idiopathic thrombocytopenic purpura, or ITP, a blood disor- 
der of unknown cause in which antibodies attack platelets. 
When the platelets are too few, a patient is vulnerable to 
extensi\'e bleeding, particularly in vital organs. To offset the 
autoimmune destruction of her own platelets, this girl had 
been receiving regular intravenous gamma globulin for more 
than a year. Although .some of the finest specialists in Boston 
had treated her, they couldn't end the predictable pattern of 
her platelet count plummeting as the infusion effects wore 
off. Furthermore, the child was suffering from severe 
headaches, chills, and abdominal pains. 

When the girl's mother asked whether there might be 
another way of breaking the cycle, I urged her to consider 
acupuncture. After several treatments, the girl's platelet 
count, which the doctors had expected to register, as usual, 
around 170,000^and which had never broken 200,000 — 
came in at 208,000. We couldn't understand how it had 
worked but had quantifiable evidence that it had worked. 

The young girl continues to receive regular acupuncture 
treatments and her hematologist has switched to a different 
type of gamma globulin preparation. She now enjoys longer 
intervals of higher platelet counts and fewer ad\'erse effects. 

Closing the Gap 

Today at least one in three Americans has sought comple- 
mentary medical treatment. Although the quality and effi- 
cacy of complementary health care varies greatly, as does 
the purity and efficacy of unregulated herbal medicines 



(which sometimes create noxious side effects 
when taken with prescribed medications), people 
are nonetheless increasingly driven to seek care 
that they perceive conventional Western medi- 
cine as failing to deli\'er. 
By the end of the twentieth century, the accumulated evi- 
dence supporting the efficacy of acupuncture led a Nation- 
al Institutes of Health conference to issue a statement that 
acupuncture is a legitimate therapy, particularly for pain 
management, and that other areas of medical treatment bear 
continued research. Yet many in the medical establishment 
insist that unless a complementary therapy passes the acid 
test of a double -blind, randomized controlled study, it does 
not merit attention. Many of the Harvard teaching hospitals 
have ongoing research projects that compare Western treat- 
ment modalities with acupuncture using blinded, random- 
ized controlled methods. My class benefited from some of 
these researchers, who were eager to share the latest results. 
There is little question that, when it comes to acute and 
catastrophic illness, Western medicine, with all its advanced 
technologies and powerful medications, is unsurpassed. 
With chronic illness, however, where the options for rehef 
are few and limited in scope. Western medicine pales. 

Fortunately, further investigation of complementary 
treatments seems to be moving in a positive direction. Many 
prestigious medical institutions have established acupunc- 
ture clinics and provided elective opportunities to medical 
students and residents. HMS is playing a key role; its Divi- 
sion for Research and Education in Complementary and 
Integrative Medical Therapies and its Osher Institute, under 
the direction of David Eisenberg '80, conduct research and 
educational programs relating to complementary medicine 
safety, efficacy, cost- effectiveness, and policy. 

In this era of growing acceptance of health care 
approaches that lie outside the purview of Western medi- 
cine, every doctor should learn about the capabilities and 
limitations of complementary medicine. It is sound prac- 
tice, for example, for all physicians to ask their patients not 
only which over-the-counter preparations but also which 
alternative medications or therapies they might be using, 
as ignorance could be deadly. Such education can be fruit- 
ful; including skilled complementary providers in the 
referral circle has certainly enhanced my medical practice 
and the lives of my patients. With open minds, we can 
become healers in the most comprehensive sense. ■ 

Earnest Wu 76 is a pediatrician at Chelmsford Pediatrics in Massa- 
chusetts. He continues to apprentice with Kiiko Matsumoto at the 
Newton Acupuncture Clinic and is a teaching assistant for a new 
class of physicians in this years acupuncture course. 



WINTER 2005 • HARVARD MEDICAL ALUMNI BULLETIN 



37 




4 



DRIFTING WITH THE TIDES: 
Years after the Khmer 
Rouge regime fell, the 
waves of refugees it pro- 
duced continue to suffer. 




what Lies 

BENEATH 



by Jason H. Wasfy 

In working with refugees traumatized by 

mass violence, a medical student glimpses the power 

of the psyche to ravage the body. 




HE PATIENT, AN ELDERLY WOMAN, OFFERED ONLY MUMBLES AS SHE FIDGETED 

fcwith the handle of a shiny, metalhc cane. Her head lay Ump to the right, 
tucked away from the people clustered in front of her: the psychiatrist; her 
son-in-law; the Cambodian health worker who served as her translator; and 
me — a petrified first-year medical student. But the psychiatrist, Richard 
Molhca, remained cool and determined to help. An expert on the medical 
and psychiatric problems of people who have experienced extreme 
violence, he began gently probing into the woman's background by asking 
the son-in-law how the problem would be defined in the Khmer language. 



WINTER 2005 • HARVARD MEDICAL ALUMNI BULLETIN 39 




BRUTAL LEGACY: The Khmer Rouge's 
landmines continue to claim victims 

eft); Cambodians have preserved 
ghastly evidence of Pol Pot's genocide 

above); these 1974 refugees (right) 
escaped the fote of the two million 
people vt^ho were murdered. 



The son-in-law described the patient as 
prouy chit, which translates to "having a 
deep sadness that is visible on her face." 
He went on to explain that she didn't 
respond to hunger, eating only when 
prompted. Night terrors kept her awake. 
She was frequently incontinent. Her 
depression often left her unable to com- 
municate with her family; she seemed 
to stew in memories of the past. 

Before the Khmer Rouge seized con- 
trol of Cambodia in 1975, the son-in-law 
told us, the woman had been mother to 
eight children; only one emerged alive 
from the ensuing genocidal madness. 
The woman had stayed in Cambodia 
with her surviving daughter, wandering 
from place to place, until immigrating to 
the United States a decade ago. The full 
details of her nightmare in Cambodia 
did not emerge in our interview; I 
sensed that not even the son-in-law 
could bear to recount them. 

The story of mass violence in a 
patient's past often emerges gradual- 
ly, as the patient-doctor relationship 
strengthens over a number of visits, 
Mollica told me later. But even in this 
initial interview, enough of the woman's 
trauma had surfaced for us to glimpse 
the depth of her pain. 

"It isn't normal for someone to be 
wetting her pants and ignoring hunger 
pangs," Mollica said, while ladling Cam- 
bodian soup into my bowl during lunch 
later that day. "Chronic depression waxes 
and wanes, but this patient hasn't 
improved in ten years." He suspected that 
she suffered from a mixed disorder, with 



neurological problems compounding a 
psychiatric reaction to the violence she 
had endured. How MolUca knew what 
clues to look for I couldn't imagine. 

Caught in the Undertow 

A week earUer, when I'd first met MoUica, 
I hadn't known what to expect; in fact, 
I thought I had the wrong address. 
Medical students tend to question 
themselves, and I was certain that this 
unimposing house nestled in leafy, 
residential Cambridge couldn't be the 
headquarters of the Harvard Program 
in Refugee Trauma. 

But the address was indeed correct. 
The receptionist ushered me into a con- 
ference room, where I found Mollica, 
the program's director, in the midst of 
telling a story. I knew he had gained 
international renown for his work with 
refugees — from Cambodia, Bosnia, and 
other conflict zones — who have experi- 
enced the trauma of mass torture, eth- 
nic cleansing, and genocide. 

After bounding up and introducing 
me to the staff, Mollica said, "I'm glad 
to have Jason with us; so few medical 
students ever visit our program." He 
explained that the center's scientific 
approach stems from the knowledge that 
trauma is heavily influenced by a person's 
cultural context and experiences. 

When Mollica founded the refugee 
program in 1981, the concept of refugee 
mental health didn't even exist in U.S. 
medicine; it was generally believed that 
little could be done to help torture sur- 



vivors regain normal lives. Yet the work 
of Molhca and his colleagues has not 
only demonstrated the enormous psy- 
chiatric distress and disability associ- 
ated with mass violence and war, but 
has also produced a model of treat- 
ment, one that has been replicated 
throughout the world. 

I was struck that day by Mollica's 
passion as he recounted patient stories 
that have informed his trauma work. In 
one, a primary care physician had been 
treating a patient with diabetes for 
seven years, with little success. The 
woman was a Cambodian refugee, and 
her failure to comply with the diabetes 
regimen was tied to a complicated — 
and undiagnosed — history of trauma. 

"Her husband had been killed," Mol- 
lica said. "She'd been raped and had 
endured multiple episodes of violence — 
but her doctor didn't know any of this. 
He had never asked — not because he 
was uncaring or ignorant, but because, 
like most physicians, he wouldn't know- 
how to cope. He was reluctant to open 
Pandora's box, because he had no treat- 
ment plan to offer." 

During the Khmer Rouge regime, the 
Cambodian government murdered two 
million of the country's inhabitants. 
The violence was so widespread that, 
in his clinical practice, Mollica simply 
assumes that any Cambodian patient 
older than 25 has endured conflict 
related trauma. 

Mollica's fusing of ethical and politi- 
cal questions with clinical diagnoses was 
what drew me to his program in the first 



40 



HARVARD MEDICAL ALUMNI BULLETIN • WINTER 2005 




The notion that vivid and terrible 
memories lay beneath trauma intimidated 
me. What if I inadvertently conjured 
up a patient's torment? 



place. I had deferred admission to med 
ical school to do graduate work in poUt- 
ical science, and I was eager to under- 
stand better how medicine — when it 
focuses on the health impact of mass \do- 
lence — could inform poUcy on subjects 
Uke human rights and foreign affairs. 

At the end of my \1sit to the program's 
main office, MolHca offered to introduce 
me to some of his patients so I could bet- 
ter understand the effects of trauma. He 
directed me to the Market Square Fami- 
ly Health Ser\'ices in Lynn, a cit)' ten 
miles northeast of Boston that is home to 
a large Cambodian population. 

The Lynn Community Health Center, 
in collaboration with the Harvard affili- 
ated Partners HealthCare, established 
the health services in 2004. The clinic 
grew out Mollica's work with the now- 
closed Indochinese Psychiatry Clinic, 
which Molhca founded in 1981 as one of 
the first in the United States to care for 
the mental health needs of refugees. 

The first patient care course in the 
HMS curriculum, Patient-Doctor L 
requires each student to undertake an 
independent project on any topic relat- 
ing to patient care. My interest was in 
caring for sur\'ivors of mass \'iolence, so 
I was shadowing Mollica to learn more 
about his refugee work. 

Of Unsound Mind and Body 

The Market Square clinic primarily 
serves Lynn s Southeast Asian and Lati 
no communities. When I arrived, I 
found its walls adorned with sturming 
artwork — Burmese tapestries, Cambo- 
dian stone rubbings from z\ngkor Wat, 
Guatemalan weavings. I learned later 
that the clinic's patients had con- 
tributed all those pieces. 



The artwork wasn't the only eye 
opening element for me. Although I had 
been learning how to conduct patient 
interviews in medical school, I walked 
into the clinic knowing this experience 
would be a challenge. Psychiatry was an 
unknown world to me. With congenital 
deformities, I could spot what was 
wrong with a patient, and I could verif)' 
many infections by peering into a micro- 
scope. But in the face of psychiatric ill- 
ness, I felt blind. The notion that vivid 
and terrible memories lay beneath trau- 
ma intimidated me. What if I inadver- 
tently conjured up a patient's torment? 

The next patient I obser\'ed at the chn- 
ic, though, presented quite differently 
from the stricken elderly woman who 
had been accompanied by her son-in-law. 
This patient was younger and more able 
to communicate, at least with the Cam- 
bodian health worker. She had come to 



the clinic for a refill of clonazepam, a 
drug that reduces anxiety and helps 
people sleep through the night. 

The problem with clonazepam is 
that patients who take it over long 
periods develop a tolerance to it. The 
patient's medical history revealed that 
she had also tried tw^o selective sero- 
tonin reuptake inhibitors, setraline and 
paroxetine. But she refused to continue 
those drugs; to her, she told the transla- 
tor, the drugs "felt like poison." 

As he talked with the patient, MoUica 
drew out some details of the woman's 
harrowing experiences. "Doctors must 
engage the trauma story cautiously and 
empathetically because discussing it 
can distress the patient further, making 
them more symptomatic," Mollica later 
explained. "This may mean bringing up 
their traumatic life experience for just 
fi\'e minutes during each medical visit. 



WINTER 2005 • HARVARD MEDICAL ALUMNI BULLETIN 



41 




The last patient that day walked into 
the clinic smiling. But I soon learned 
her demeanor masked a history of 
depression and anxiety 



I 



Waves of Despair 




s countries struggle to cope with the devastating 
aftermath of the recent tsunami, the Harvard Program in Refugee 
Trauma (HPRT) at Massachusetts General Hospital has offered its 
resources and expertise to help the untold number of traumatized 
survivors bolster lives and spirits flattened by the deadly v^^aves. A 
team from the HPRT, including Richard Mollica, the program's 
director and an HMS professor of psychiatry, was invited to 
Indonesia to help develop a plan for administering what Mollica 
calls "a mental health action plan for disaster recovery." 

Few organizations have had more experience in devising such 
plans. HPRT experts have worked with Cambodian refugees in Thai 
camps, civilians caught in the crossfire of conflict in 
East Timor, people living in postwar Bosnia-Herzegov- 
ina, and survivors of the catastrophic 1995 earth- 
quake in Kobe, Japan. These experts hove also 
trained and assisted health and mental health 
providers caring for the survivors and the families of 
victims of the September 1 1 attacks in New York City, 
and they offer community-based clinical care to torture 
survivors living in Massachusetts. The program's multi- 
disciplinary approach has pioneered in the health 
and mental health core of traumatized refugees and 
civilians for more than two decades. 

Despite those long years of work, the idea of treat- 
ing the psychological effects of trauma — such as 
depression — on a large scale has been slow to develop 
traction. Mollica recognizes that individual counseling 
and antidepressants aren't feasible methods for treating 
suffering as widespread as that after a tsunami. The 
emphasis, he soys, should be on fostering resiliency 
and tapping into individuals' altruistic instincts and spir- 
itual strength. He recommends putting survivors to work 



rebuilding their communities, getting children back in school as early 
as possible, engaging adolescents in community service, and rebuild- 
ing houses of worship. "The worst thing you can do for trauma sur- 
vivors is to foster long-term dependency by forcing them into camps 
or orphanages where they can't take action to help themselves," 
Mollica says. "The busier they are rebuilding their lives, the less like- 
ly they ore to sink into despondency." 

Mollica also advocates involving local health practitioners, 
healers, and community organizers in the psychological recovery 
process because they are the ones who will be dealing with the 
lingering effects of trauma. ■ 




SPIRIT HEALER: Richard Mollica has been delivering psychological first aid 
to trauma survivors for more than t^o decades. 



42 



HARVARD MEDICAL ALUMNI BULLETIN • WINTER 2005 



1^ 




LOST SOULS: A pre-interrogation photo of one of the victims of the Khmer Rouge Torture Center at Tuol Sleng. The Khmer Rouge 
documented every step of the torture process, including before and after pictures. 



But over time the full story unfolds, and 
you can better understand how to treat 
your patient." 

The trauma story often in\'ol\es a 
secret — such as rape — that the sur\ivor 
of violence desperately wants to conceal 
from others, Mollica added. It is also the 
imprint of history on that person s mem- 
ory; a narrative, usually reviewed in 
nightmares, that the mind retells daily 
as it searches for meaning. And the trau- 
ma story becomes the centerpiece of 
therapy. When healers know what 
patients have endured, they can estab- 
lish trust and provide survivors with 
insights into the lingering effects of the 
experience of violence on their lives. 

The last patient that day walked into 
the chnic smiling. But I soon learned 
her demeanor masked a history of 
depression and anxiety. I gripped her 
three-inch thick medical file in my 
hands with no idea where to begm. She 
felt "okay," she told us, although upset 
by her long stay in the clinic waiting 
room. As she talked, she began to dab 
at her eyes. Then she started sobbing. 
The Cambodian health worker rested 
her hand on the woman's arm. 



Through her tears, the patient revealed 
to us that in addition to her struggles 
with insomnia and depression, the shrap- 
nel embedded in her thigh often sent a 
shooting pain down her right leg. Mollica 
listened to her closely, then gingerly 
tried to help her understand the connec- 
tion between her psychological suffer- 
ing and her somatic pain. 

"The organic problem," Mollica 
told me later, "is embedded in the 
mental state. Pain feels worse when 
you're depressed. We now know that 
there is a real biology to pain. Most 
researchers no longer believe there are 
purely psychosomatic diseases." 

I realized that my initial discomfort 
with Mollica's patients had stemmed 
from the seeming abstraction and elu- 
siveness of the etiology of psychiatric 
disease. Yet my assumptions had proved 
wrong, just as they had when I thought 
the small house in leafy Cambridge 
could not possibly be the refugee pro- 
gram's headquarters. 

Perhaps I should have taken that les- 
son as a prophecy of what I would learn 
in my first experience with the psychi- 
atric treatment of patients who have 



endured one of the world's most 
appalling episodes of mass violence. In 
psychiatry, I learned, the tangible and 
the elusive are linked. Events that a 
patient sometimes cannot even recall 
clearly can nonetheless torment, and 
somatic disease makes limited sense 
viewed outside the context of the more 
abstract mental state. 

I have only begun the work of under- 
standing the enormous burden that sur- 
vivors of mass violence carry. But I have 
become more convinced than ever that 
doctors — and those of us training to 
become doctors — must reinvigorate our 
efforts to examine the sources of these 
patients' pain. And we must never fail to 
remind policy makers and poUtical lead- 
ers of the importance of humanitarian 
intervention. Putting an end to ethnic 
conflicts and genocide not only saves 
fives, but it also reduces the psychiatric 
trauma that can haunt survivors for 
many years after the violence ends. ■ 

Jason H. Wasfy '07 is a second-year student 

at Harvard Medical School. Visit www. 
hprt'Camhridgc.org for more information 
about the Harvard Program m Refugee Trauma. 



WINTER 2005 • HARVARD MEDICAL ALUMNI BULLETIN 



^"■■^: 



REGARDING" 




OMES HARV 




HENRY 




HE TURNED TO A "BLEEDER," WHO EXTRACTEE 



FOR THREE DAYS HENRY LEE 



Ml 

^^^Z Higginson's head pounded. 

r^^^m^ He had been studying piano 

in Vienna, and the renowned 
physician recommended to 
him was out of town. In des- 
peration, Higginson turned to 
a "bleeder," who extracted a "tum- 
blerful" from a vein in the musician's left arm. ReUef came 
instantly, but heartbreak soon followed; impatient to 
resume playing almost immediately, Higginson inflicted 
permanent injury to his arm, cutting short his dreams 
of pursuing a career as a pianist. For Higginson, the 



Higginson as a< 
Union soldier 



blow must have been crushing; he had written to his 
father that nothing was more refining than music, no 
antidote against evil greater. But his personal disap- 
pointment would become the medical world's gain; 
ironically, the injury Higginson sustained in resort- 
ing to the bloodletter's shady practice would steer 
him on a philanthropic path that made possible the 
purchase of the land on which Harvard Medical 
School now sits. 

Throughout his life, Higginson, who was born in 
1834 in New York but spent nearly all his life in Boston, 
deftly transformed unexpected adversity into opportu- 
nity. Poor eyesight compelled him to suspend his edu- 
cation only six months into his studies as a member of 
Harvard College's Class of 1855. Although he never 
completed his degree, Higginson forged strong ties 
with several of his classmates, including James Jackson 
Lowell, James Savage, Jr., Stephen Perkins, Robert 
Gould Shaw, and Charles Russell Lowell, Jr. All these 
friends died on Civil War battlefields, but Higginson 
would honor their memory — and the legacy of their 
friendship — until his own death. 

Not long after injury had dashed his musical aspira- 
tions, Higginson considered a career as a wine mer 



chant. But the outbreak of the Civil War scut- 
tled that ill-fated endeavor. Long a committed 
abolitionist, Higginson was among the first to 
enlist in the Union Army. Once again, bad for- 
tune followed him; in 1863, he was severely 
wounded in the Battle of Aldie, in Virginia. 
Knocked to the ground and struck in the head 
by a man he had unhorsed, Higginson later 
described the ordeal in his diary: "He then pro- 
posed to take me prisoner, but I told him I 
should die in a few minutes, for I put my hand 
and found a hole in my backbone. He took 
what he could get of my goods, and rode off." 
Yet Higginson survived, to display proudly on 
his right cheek a scar from a saber wound. Dur- 
ing his convalescence, he married Ida Agassiz, 
the daughter of Harvard zoology and geology 
professor Louis Agassiz. 

The return to ci\'ilian life after the war saw 
Higginson enter into new business ventures — 
and meet with fresh disappointments. His first 
major undertaking was a scheme to raise cotton 
on a Georgia plantation, but that fell into bank- 
ruptcy within two years. The experiment's 
failure also ended his Utopian dream of estab- 
lishing a school for the children of the former 
slaves on the plantation. Higgin,son returned to 
Boston, at the age of 33, more than $10,000 in 
debt, to live in a small apartment with his wife. 

The idealistic Higginson, strapped for a means of 
support, reluctantly entered his family's brokerage 
firm. But over time his diligent work ethic made him 
moderately wealthy. Once in a position to do so, he 
began investing his prosperity for the common good 
with an enthusiasm he never could manage to summon 
for business. By the end of his life, Higginson had cre- 
ated a legacy as one of the greatest philanthropists in 
Boston's history, if not the nation. 

Higginson's vision of a world-class symphony orches- 
tra for Boston arose out of his passion for music. In 1887 
he discovered a plot of land on Huntington A\'enue in a 
sparsely populated site of former tidelands and mudflats 
that had only recently been com-erted into solid ground 
as part of the Back Bay landfill. It seemed an unlikely 
place to build an orchestra house. But, together with 
wealthy patrons of Boston, Higginson encouraged 
investment in the project and succeeded in raising 
$400,000 in just tens days' time in the midst of the finan- 
cial panic that engulfed the nation in the summer of 
1893. Symphony Hall opened seven years later with a 
gala celebration. Higginson remained the symphony's 
moral and financial mainstay for 38 years. 



46 



HARVARD MEDICAL ALUMNI BULLETIN • WINTER 2005 



cc. 



A TUMBLERFUL" FROM A VEIN IN HIS ARM 




Higginson also gave generously to educational insti- 
tutions, including a model college in Santiago, Cuba. 
But he contributed the most to the university that 
should ha\'e been his alma mater. Among his gifts was 
the Harvard Union for all students, where, he stated, 
"should centre all the college news, of work, athletics, 
sport...and there, we hope, may be found a corner and 
a chair and a bit of supper for the old and homeless 
alumni from other cities." 

In 1882, Higgin.son signed the Articles of the Associ- 
ation that incorporated the "Harvard Annex," an off- 
shoot of Harvard College that provided instruction 
exclusively to women, into "The Society for the Colle- 
giate Instruction of Women." A dozen years later, this 
"society" was chartered as Radcliffe College, with 
Higginson serving as an associate of the go\'erning 
board and as its first treasurer. 

And in 1890, Higginson donated a 31 -acre plot of 
land to Harvard College for the recreational needs 
of students. "My only hope," he said in his dedication 
speech, "is that the ground shall be called 'The Sol- 



MARBLE MARVEL: In 1906 an 
impressive gathering attended the 
dedication of Harvard Medical 
School's Quad, whose construction 
Higginson's financing plan had 
helped make possible. 



dier's Field' and marked 

with a stone bearing the 

names of some dear 

friends — alumni of the 

University, and noble 

gentlemen — who gave 

freely and eagerly all that they had or hoped for, to 

their country and to their fellow men in the hour of 

great need — the war of I86I to 1865 in defense of 

the Republic." 

Yet one of the lesser known of his efforts is the crit- 
ical role Higginson played in determining the future 
of Harvard Medical School. As an influential fellow of 
the Harvard Corporation, he supported the vision 
of two HMS professors, Henry Pickering Bowditch and 
John Collins Warren, to purchase the Francis Estate, a 
26-acre property bordering Longwood Avenue. 

At the end of the nineteenth century the School was 
located on Boylston Street near Copley Square, adja 
cent to the Boston Public Library. Although the School 
was pressed for space. Harvard University President 



WINTER 2005 • HARVARD MEDICAL ALUMNI BULLETIN 



47 



u 



MAY YOU KEEP STEADILY BURNING THE FIRE 
OF HIGH IDEALS, ENTHUSIASM, AND HOPE." 




LOOMS WITH A VIEW: The Quad's five 
imposing marble buildings came to 
dominate the once open expanse of the 
Francis Estate. The plan required more 
exterior marble than had been used in 
Boston during the previous 20 years. 



Charles Eliot had been 
unwilling to advance 
university funds to the 
project without a strong 
show of public support. 
From the time discus 
sion to buy the Francis Estate began in 1899, Eliot 
insisted on a "university policy of taking no pecuniary 
risks in buying land for the future use of the school." 
Partial success in the fundraising endeavor for HMS 
came from substantial financial commitments from 
New York's J. P. Morgan and John D. Rockefeller, but 
the effort fell short of the required investment of four 
million dollars. 

Despite university policy, on May 5, 1900, even as 
construction was rushing forward to completion of 
Symphony Hall, the Medical School faculty — led by 
Bowditch, Warren, and Theobald Smith — unani 
mously voted to purchase the estate, only to grow 
nervous, soon after, about the possible purchase of 
the land by another buyer before the School could 
raise the necessary funds. 

So Bowditch and Warren sought other means of 
reserving the Francis Estate. They approached Hig 
ginson, who suggested that the Medical School use 
the same method he had employed in reserving the 
Symphony Hall site prior to construction. He sug- 
gested that 15 to 20 prominent businessmen invest 



between S10,000 and 850,000 in the land purchase 
for the Medical School. 

A memorandum of agreement was drawn on August 6, 
1900, which stated, in brief, that the investors would 
hold the land for Harvard for up to 57 months. If the 
Medical School decided to relocate to the Francis 
Estate, the investors would sell the land to the School 
at cost. But if the School chose another location, the 
landowners could dispose of the land as they wished 
and keep any profit from the sale. Within a few months, 
8565,000 had been raised from 20 investors; Higgin- 
son himself invested 850,000. 

In a letter to Bowditch outlining the syndicate pur- 
chase of the land, Higginson wrote that he was 
impressed with the professors' financial acumen and 
explained why he had organized the effort: "You and 
Collins Warren are very clever and can induce men to 
take this risk. It is very small and there is the chance 
of profit....I am willing to stand my chance of the loss 
on this land when I consider how much good may 
accrue to the Medical School by its purchase now." 

Architects were selected and ground was broken in 
September 1903 for the five massi\-e marble buildings 
that would form the original Quad. One hundred years 
later, on September 24, 2003, the School commemorat- 
ed the opening of the New Research Building on the 
site, the largest construction of a single building that 
Harvard Univcrsitv has ever undertaken. 



48 



HARVARD MEDICAL ALUMNI BULLETIN • WINTER 2005 




Higginson was a seminal figure at the turn of the 
twentieth century, whose generosity and high ideals 
inspired others of his generation. At the formal dedi- 
cation of the Harvard Union on October 15, 1901, as 
on other occasions, he called on the students to 
uphold the fundamental values and ideals that had 
guided him throughout his life. He was the last 
speaker that day. 

"In these halls may you, young men, see \isions and 
dream dreams," he told the students, "and may you keep 
steadily burning the fire of high ideals, enthusiasm, and 
hope, otherwise you cannot share in the great work and 




ESTATE OF THE ART: A genteel crowd 
turned out to celebrate the formal 
transformation of the Francis Estate 
into the site >vhere HMS students and 
faculty would practice the art and 
science of healing. 



QUAD SQUAD: It v/as Higginson's financial acumen 
that turned Henry Pickering Bo%vditch's and John 
Collins Warren's vision for HMS into reality. 



glory of our new centu- 
ry.. ..Every honor is open 
to you, and every victo- 
ry, if only you will dare, 
will strive strongly, and 
will persist..." 

Historical events and individual circumstances fre- 
quently form a constellation that shapes the future, as 
well as the cultural and social environment of that 
future. It is often the vision of a single individual that 
kindles that constellation and thus defines critical 
moments that become the substance of history. It is 
worth recalling Higginson, his deeds, and the way he 
helped build the future for Harvard, for Boston, for the 
nation, and for the world. If not remembered from 
time to time, that history inevitably dims, and the 
present — that which began as a vision for Higgin- 
son — is poorer for it. Our lives would be fuller and 
more inspired if, when looking at these buildings and 
walking through these halls, we would occasionally 
remind ourselves of the spirit of a man who captured 
every opportunity to transform the present into a bet- 
ter future. ■ 

Joseph B. Martin, MD, PhD, is the dean of Harvard Medical School. 

The author wishes to thank Nora Ncrccssian, PhD, the former asso- 
ciate deanjor alumm programs and special projects at HMS, for her 
kind assistance in reviewing this article 



WINTER 2005 • HARVARD MEDICAL ALUMNI BULLETIN 



49 





XAH BUI 




k 




t's common for people in the community to stop taking a course o 



TW 



r^'f 



by Beverly Ballaro 



PRACTICAL 

MAGIC 



THESE DAYS, MORE AND MORE HMS STUDENTS ARE TAKING THEIR 

medical education to the streets — and to mountain hamlets, desert 
encampments, and coastal villages all o\'er the globe. Since the Division 
of Service Learning — now under the direction of David Urion — began to 
take shape in 1998, HMS students have enthusiastically embraced the 
educational opportunities it offers. Nearly two-thirds of today's students 
engage in community ser\ice during their first year and, in 2004, some 50 
students traveled abroad to 
do so. ■ "It's a win win pro 
gram, uniting rigorous acad 
emic study with volunteer 
community service," says 
Jean Hess, who serves as 
an associate director, along 
with Elizabeth Miller '92. 
"We measure its success not 
only by what our students 
learn, but also by the useful- 
ness of their work to those 
they serve." ■ 



From refugee 

camps to 

inner cities, 

service learning 

students are 

stretching the 

bounds of an 

HMS education. 



M 



~ANH BUI- 



ANGO AND MUNG BEANS ARE COLD FOODS," EXPLAINS ANH BUI 'O5. 

"Cherries and chives are warm — but then again, so is ice 

cream." Bui's knowledge of what may seem counterintuitive 

to people not steeped in Asian cultures played a key role 

in the success of her service learning project with Boston's 

X'ietnamese immigrant community. For local broadcast, Bui worked with the 

X'ietnamesC'American Civic Association to prepare Vietnamese-language 

television segments on such topics as hypertension, diabetes, and hepatitis. 

In addition to explaining the causes, symptoms, transmission modes, and 

treatments of common diseases, Bui encouraged her audience to learn new 

ways of navigating their health care needs. "It can be tough," Bui says, "for 

many immigrants, particularly older ones, to make the cukural leap to the 

American health care system." 

Bui helped patients understand what to expect from a typical clinical 
encounter and how to weigh medical decisions. She also tackled one of the most 



¥ 




antibiotics as soon as they start feeling better. 



— ANH BUI 



WINTER 2005 • HARVARD MEDICAL ALUMNI BULLETIN 



51 



pressing medical issues facing the Viet 
namcse community: drug compliance. 
"It's common," says Bui, "for people to 
stop taking a course of antibiotics as 
soon as they start feeling better. They 
often hoard the remaining medication to 
take for future ailments or to dispense 
to family members." 

Bui tried to frame her advice in terms 
that would be culturally accessible to a 
population more accustomed to seeking 
relief from herbal remedies than from 
prescription drugs. "You believe that 
your health depends on maintaining a 
balance," she would point out. "Your 
herbalist always evaluates your condi- 
tion before putting together a mixture 
that is just right for you, and you always 
finish the whole teabag, don't you? And 
so it is with antibiotics, which must be 
finished to yield their full benefit." 

Bui's understanding of traditional 
Vietnamese thinking helped her to tai- 
lor other health promotion efforts in 
culturally specific ways. In the televi- 
sion segment on hepatitis, for example, 
she emphasized the risk factor in food 
sharing, knowing that most Vietnamese 
eat their meals family-style. "It was eye- 
opening for many people," she says, 
"that they could prevent serious illness 
by doing something as simple as using 
a spoon to serve individual portions 
instead of everyone using chopsticks to 
eat from communal bowls." 

For Bui, the service learning experi- 
ence has infused her medical education 
with a measure of irony. "When my 
father, an internist, came to this country, 
he had to translate his Vietnamese med- 
ical training, credentials, and vocabulary 
into American terms. The immigrants in 
Boston have taught me in the reverse 
direction; I've had to relearn my Ameri- 
can medical vocabulary in Vietnamese." 
Bui hopes to bring the connection full 
circle by providing health care to the 
Vietnamese community when she fin- 
ishes her medical training. ■ 




-KEDAR MATE- 



LTHOUGH MEDICINE PROVIDES A PATH TO COMMUNITY' SERVICE FOR 

many, the reverse pro\'ed true for Kedar Mate '05. While 



A researching his undergraduate thesis on HI\' among Haitian 
immigrants. Mate encountered the WTitings of Paul Farmer '90, 
for whom he eventually found himself working at Partners in 
Health. "I was assisting people from different disciplines," says Mate, "but 
they were all committed to the same goal: providing poor patients with 
access to world-class treatment for tuberculosis and HI\'. I started out not 
at all convinced that I wanted to go into medicine, but seeing the docs in 
action erased my doubts." 

At HMS Mate began working with the Prevention and Access to Care 
and Treatment (PACT) Project. His role focused on motivating HIV-infect- 
ed people to comply with highly complicated daily drug regimens. Mate 
helped adapt a strategy that had already proved successful in assisting 
tuberculosis patients. "Directly observed therapy, or DOT," explains Mate, 
"is essentially a buddy system. We trained caseworkers to visit patients' 
homes so they could witness the patients taking their meds." 

For many people with HIV, Mate notes, the ravages of the virus itself 
make compliance difficult. One such person was a woman in her twenties, 
whom Mate got to know in the early phase of the program, when he was 
doing the casework himself. "When I first met 'Claudia' her CD4 count, 
which measures the immune system's strength after a diagnosis of HIV 
infection, was in the single digits — in contrast to a healthy adult's count, 

THERE'S NO PLACE LIKE HOME: Kedar Mate has used caseworker home visits 
to promote better drug compliance among people living with HIV. 



^ 



started out not at all convinced that I wanted to go into medicine, 
Dut seeing the docs in action erased my doubts." -kedar mate 



52 



HARVARD MEDICAL ALUMNI BULLETIN • WINTER 2005 



The students gained firsthand knowledge of people with 
disabilities leading rich, meaningful lives." -brianskotko 



which might be in triple or even 
quadruple digits," recalls Mate. "On 
top of battling HIV, she suffered from 
DiGeorge syndrome, a rare congenital 
disease whose symptoms can include 
cognitive and mental deficits. She was 
totally overwhelmed and unable to 
keep up with her meds." 

When the Department of Social 
Services (DSS) suspected that Claudia's 
young daughter wasn't growing because 
of maternal neglect, they removed the 
child from her mother's custody. "Clau- 
dia was devastated," recalls Mate, "and 
adamant that she had been caring prop 
erly for her httlc girl." PACT helped to 
broker a deal wdth DSS, whereby it was 
agreed that Claudia would get her 
daughter back if she adhered, with 
PACT'S supervision, to her medication 
regimen. Claudia quickly became a 
model of comphance. 

"As it turns out," Mate says, "Clau- 
dia had been telling the truth; her 
daughter didn't grow in the foster 
placement either. The child had simply 
been slow to catch up with her peers 
in terms of physical development. And 
within weeks of returning to her 
mother's care, she attained a healthy 
weight. Claudia's health also improx'ed; 
her CD4 count rose significantly and 
her viral load plummeted to unde 
tectable levels." 

Although success stories like Clau- 
dia's are convincing. Mate acknowl- 
edges a widespread reluctance or 
inability to invest in an approach as 
resource intensive as DOT. He is hope 
ful, though, that by carefully screening 
potential patients, DOT program 
administrators can judiciously limit its 
use to those who could benefit the 
most. And he finds encouraging the 
program's success in fulfilling its ulti- 
mate goal — teaching patients to take 
independent responsibility for their 
own treatment regimens. "Reducing 
the sheer number of pills people have 
to swallow each day," says Mate, "will 
certainly go a long way to ensuring 
better compliance." ■ 



^ 



-BRIAN SKOTKO- 

VOLUNTEER AND ADVOCACY EFFORTS HAVE FORMED AN INTEGRAL PART 
of Brian Skotko's life for as long as he can remember. Growing up 
with a younger sister wdth Do\\'n syndrome inspired Skotko '06 
to focus on developmental pediatrics and to dream of a future role 
as a disability-rights pohcymaker. To that end, he is simultane- 
ously pursuing a master's degree in pubHc policy from Harvard's Kennedy 
School of Government. 

As his initial ser\ice learning project at HMS, Skotko helped revamp the 
curriculum in the genetics course that all first-year students take. "The course 
offered a tremendous amount of clinical information about people with cogni- 
ti\e or developmental disabihties but no opportunities to interact with people 
h\'ing with those disabilities," says Skotko. So he co-organized a series of 
lunchtime seminars — More to Life than Genes — that each week focused on a 
different theme, such as Dowti syndrome, Rett syndrome, or Tay-Sachs dis- 
ease. For many students, the seminars offered an invaluable reality check. 
"They gained firsthand knowledge," Skotko says, "of people with disabihties 
leading rich, meaningful h\'es full of possibilities and expectations." 

Skotko's ambitions soon extended beyond the classrooms of HMS. Again 
with the support of the Division of Service Learning, he traveled to Spain, 
where he mailed more than 6,000 surveys to mothers of children wdth Down 
s)'ndrome. His research, to be published in the June 2005 issue of Mental Retar- 
dation, aimed "to capture the sentiment and ethos of what it was like to get a 
postnatal diagnosis." Skotko then conducted a similar survey of more than 
3,000 mothers in the United States. The results of his American survey appear 
in the January 2005 issue of Pediatrics. 

Skotko asked the mothers to evaluate how their physicians had com- 
municated a postnatal diagnosis of Down syndrome. "Most mothers 
expressed intense frustration," he says. "In many instances, doctors did an 




SEEING IS BELIEVING: Brian Skotko is trying to raise awareness of the dignity 
and potential of people living with disabilities. 



WINTER 2005 • HARVARD MEDICAL ALUMNI BULLETIN 53 



excellent job of conveying the clinical 
aspects of Down syndrome, but they 
tended to fall far short in terms of com 
passion and understanding." 

Based on the mothers' feedback, 
Skotko came up with a ten point pre 
scription for physicians to consider when 
deli\'ering a postnatal diagnosis of Down 
syndrome. The recommendations include 
the specific and commonsensical. The 
person communicating the diagnosis, for 
example, should be a physician (some 
mothers surveyed had recei\'ed the news 
from nurses, lactation specialists, or 
even, in one case, a candy striper). The 
doctor also should share suspicion of the 
diagnosis as soon as possible, but not 
until the mother is appropriately settled 
(some mothers received the news as their 
episiotomies were being stitched up). 

Perhaps most important, Skotko 
says, is that doctors set an appropriate 
tone. "Many mothers reported feeling 
devastated," he says, "when their physi- 
cians began the conversation with 
phrases like, Tm sorry,' or 'I have some 
bad news,' or 'I don't know how to say 
this but...' Mothers with the best expe- 
riences, by contrast, praised physicians 
who offered congratulations before 
communicating their suspicions of a 
Down syndrome diagnosis, and who 
added positive comments such as, 'Your 
child is going to bring great richness 
and warmth to your family.' " 

Skotko's companion paper, in the 
March 2005 issue of the American journal 
of Obstetrics and Gynecology, summarizes 
the responses of women whose babies 
received a prenatal diagnosis of Down 
syndrome and offers a seven-point pre- 
scription for obstetricians, genetic coun- 
selors, and other clinicians involved in 
prenatal care. "They can expect to be 
challenged," says Skotko, "but, then again, 
we all can, in the campaign to create a 
better understanding and appreciation 
of people living with disabilities." ■ 




-SAMAR HASSOUNEH- 



YOU'RE PALESTINIAN," THE PARENTS OF SAMAR HASSOUNEH '08 
repeatedly reminded her, even though she spent most of her child- 
hood in Jordan and has only twice set foot in the land her parents 
fled many years ago. Hassouneh's cultural identity and heritage 
ha\'e played defining roles in her commitment to ser\ice learning. 
When she heard about a program called Bridging the Gap, which matches med- 
ical students with refugee families, she volunteered, figuring her Arabic could 
help her connect better with some of the people served by the program. 

Hassouneh found herself assigned to a Sudanese family li\ing in an impov- 
erished, largely immigrant community in Chelsea, Massachusetts. "I grew up 
seeing how stressful it was for my parents to maintain a connection with their 
Palestinian roots while mo\ing from one country to the next," Hassouneh says, 
"so I was happy to help this family find their way in their adopted homeland." 
Hassouneh got to know three generations of the family, especially one 
daughter who was in the midst of the college application process but had 
little understanding of how to navigate it. Obtaining the right education, 
Hassouneh knew, was critically important to this teenager; the high 
school senior had watched her older sisters, both of whom had earned uni- 
versity degrees in the Sudan, struggling to translate their credentials in 
order to find professional jobs in the United States. "They were working," 

FOUND IN TRANSLATION: Samar Hassouneh's command of Arabic led her to 
service learning experiences that have reaffirmed her cultural legacy. 



^ 



grew up seeing how stressful it was for my parents to maintain 
a connection with their Palestinian roots." -samar hassouneh 



54 



HARVARD MEDICAL ALUMNI BULLETIN • WINTER 2005 



"If the program inspires some future plastic surgeon to do volunteer 
surgery abroad 20 years from now, that's great." -marycatherine arbour 



1^ 



recalls Hassouneh, "at Dunkin" Donuts 
and McDonald's." 

Hassouneh arranged to spend the fol- 
lowing summer in a Palestinian refugee 
camp in Jordan. Working alongside 
physicians, she conducted interviews 
with diabetic and hypertensi\'e patients 
among the camp's nearly 150,000 inhab- 
itants. "Many of these people could 
choose to live intermingled in Jordanian 
society — as many Palestinians do," says 
Hassouneh. "But they have deliberately 
opted to remain in the camps. By doing 
so, the)' retain their refugee status and, 
they hope, a claim to future compensa- 
tion for lost land." 

In the camp's generally conser\'ati\'e 
atmosphere, Hassouneh's lack of head 
covering and U.S. medical training made 
her unusual. Yet she found an extraordi- 
narily warm reception by the camp's 
inhabitants. Their generosity, she says, 
was all the more striking, gi\'en their 
limited resources. 

"It could be heartbreaking at times," 
she says. "Once the family of a young 
man with a crippling cervical spine 
injury pleaded with me to help get him 
to America for treatment. But how do 
you break it to the loved ones of a per- 
manently disabled person that some 
conditions are beyond the scope of 
recovery, even in the States?" 

Despite the poverty and lack of 
health care resources she witnessed, 
Hassouneh was continually struck by 
the resilience of spirit she saw all 
around her. Choosing optimism in the 
face of despair was a lesson she hopes 
to incorporate into her future career in 
international medicine. "You'd see peo- 
ple hving in tiny, unfurnished homes 
roofed only by a sheet of metal or maybe 
even cardboard," she says. "Yet when 
you asked them how they were doing, 
they'd reply, 'Oh, life is good! God is tak- 
ing care of us for now, and we'll go back 
home some day.'" If and when they do 
return — or even if they don't — Has- 
souneh, inspired by her experience with 
the Division of Service Learning, plans 
to contribute to their care. ■ 



-MARYCATHERINE 
ARBOUR- 



A 



LTHOUGH HMS WAS STILL IN THE PROCESS OF CREATING ITS DIVISION 

of Service Learning when MaryCatherine Arbour '05 arrived 
at the School, she was quickly recruited to help: faculty orga- 
nizers consulted her in 
designing and e\'aluating a 
service learning program in Chile, a 
country where Arbour had lived for 
three years before matriculating at HMS. 
Arbour — who had worked for sever- 
al years in anthropological research, 
church-sponsored community organiz 
ing, and migrant health services before 
deciding to study medicine — was 
happy to help out. To vet prospective 
service learning sites for HMS stu 
dents, she visited more than a dozen 
organizations in Chile, ranging from 
large Catholic social service organiza 
tions to a tiny orphanage to a rural 
peasant settlement. 

While the official goal of the pro 
gram, says Arbour, is to afford HMS 
students opportunities to learn Spanish 
and provide community service, "what 
it's really all about is exposure. If, in 
every cohort, even a couple of students 
experience a crystallizing 'aha' moment 
in their thinking about how they will 
integrate their skills down the line, it's 
worthwhile. If the program inspires 

some future plastic surgeon to do two weeks of volunteer surgery abroad 20 
years from now when he or she can afford to do so, that's great." Arbour 
hopes that the Di\ision of Service Learning will one day be in a position to 
fund the involvement of all students who want to participate in interna- 
tional service learning. 

Such opportunities, she believes, are in\aluable. "Once when I asked one 
of the Chilean host organization leaders how big a role language barriers 
might have played in determining the outcome of some of the students' 
experiences," Arbour recalls, "she told me she didn't care about how much 
Spanish the students knew. What she really wanted in her volunteers was 
what she called cntrcga — a spirit of giving of oneself. The Division of Service 
Learning provides an ideal forum for future doctors to observe and culti- 
vate this spirit. It's easy to portray the students engaging in these service 
learning experiences as heroes. But I suspect the students would tell you 
that the real heroes are the people who, with unflagging cntrcga, are com- 
mitted to doing this work all the time — day in and day out — despite their 
limited resources." ■ 



WINTER 2005 • HARVARD MEDICAL ALUMNI BULLETIN 55 




CHILE RECEPTION: MaryCatherine 
Arbour helped HMS students do 
service learning abroad. 




ODDSMAKER: 
Tiffany Jackson 
has v/orked to 
improve the 
prospects of 
teenage mothers 
and their babies. 



-TIFFANY JACKSON- 



^f^ 



NOT LONG AFTER TIFFANY JACKSON '0/ ARRIVED AT HMS, SHE DECIDED 
she needed to go global to take her medical aspirations local. With 
the vision of one day practicing obstetrics and gynecology in 
underserved communities, Jackson sought to develop a stronger 
command of Spanish to allow her to communicate more effective- 
ly with her patients. 

The Division of Service Learning afforded Jackson, in the summer following her 
first year at HMS, the opportunity to embark on eight weeks of intensive language 
studies in Chile. She put her steadily sharpening language skills to use teaching 
healthy eating habits to children at a community center in a disadvantaged neigh- 
borhood of Santiago. "It was striking," Jackson says, "to witness the full effects of 
poverty. I would see obese and undernourished children standing side by side." She 
also participated in a rural health services project in a remote northern region, 
working alongside a team of Chilean physicians and medical students. 

Upon her return to HMS, Jackson continued her commitment to simultane- 
ously learning from and reaching out to people whose life experiences differ rad- 
ically from her own. She joined BABIES (Boston Adolescent and Baby Initiative to 
Ensure Success), a program that Tarayn Grizzard '05 had created to pair up young 
mothers-to-be with medical student mentors. "The girls range in age from 15 to 
22," says Jackson. "They're considered at-risk, but they're also motivated to give 
their babies a positive start in life." 

The medical students accompany the girls to prenatal appointments, but their 
support isn't only clinical. "To estabhsh good rapport, the first thing we did was to 
take the girls bowling," says Jackson. "But even there, we subtly tried to encourage 
healthy behavior, by urging them to choose juice instead of soda, for example." 



The service learning process, though, 
runs two v^-ays, Jackson adds. "I learned 
quite a bit from the young woman with 
whom I was matched, about just how 
complicated patients' lives can be. I 
watched her juggle, at an age similar to 
mine, responsibihty for two young chil- 
dren while also attending nursing school. 
I got to witness a life very different from 
my owTi, and I hope this experience will 
help me become a better doctor." 

And being an excellent doctor, adds 
Jackson, takes more than the wealth of 
knowledge a\aLlable in Harvard's class- 
rooms and laboratories. "You get so 
caught up in learning the science of heal- 
ing," she says, "that it's easy to lose sight 
of the complete, rich fabric of patients' 
Uves. The Di\'ision of Ser\ice Learning 
reminded me that I don't ha\'e to sacrifice 
the passion that led me to medicine in 
the first place." ■ 

Beverly Ballaiv is associate editor of the 
Harx'ard Medical .Alumni Bulletin. 



To establish good rapport, the first thing we did was to take 
the girls bowling." -tiffany jackson 



56 



HARVARD MEDICAL ALUMNI BULLETIN • WINTER 2005 




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